Application of emerging technologies to improve access to ischemic stroke care

Abstract

<jats:p>During the past 20 years, the traditional supportive treatment for stroke has been radically transformed by advances in catheter technologies and a cohort of prominent randomized controlled trials that unequivocally demonstrated significant improvement in stroke outcomes with timely endovascular intervention. However, substantial limitations to treatment remain, among the most important being timely access to care. Nonetheless, stroke care has continued its evolution by incorporating technological advances from various fields that can further reduce patients' morbidity and mortality. In this paper the authors discuss the importance of emerging technologies—mobile stroke treatment units, telemedicine, and robotically assisted angiography—as future tools for expanding access to the diagnosis and treatment of acute ischemic stroke.</jats:p>

First-in-human, robotic-assisted neuroendovascular intervention

“…In neurosurgery, robotic assistance has been used for epilepsy evaluation,5 subcortical surgery6 and spine surgery 7. We identified only one report of a robotic system used for cerebral angiography, in which Vuong and colleagues8 describe the use of the Magellan Robotic Catheter System (Hansen Medical, Mountain View, California, USA), but no intervention was performed nor was the system adapted to microcatheter and microwire manipulation.…”

Retrospecting atrial fibrillation and stroke severity: impact onset time of acute ischemic stroke

“…Rather, it was the factors that impact during prehospital time, here defined as the onset time, that were studied. Prehospital time was found to be only linked to prehospital transport, optimized by mobile stroke treatment units, or telemedicine or robotically assisted angiography, (Vuong et al, 2017) although few factors were investigated.…”

“…There have been a series of magnetic resonance imaging (MRI) studies that estimate stroke onset time (Berthet et al, 2014;Jokivarsi et al, 2010;McGarry et al, 2017). However, with the exception of prehospital transport (Vuong et al, 2017), little has been reported about the onset time factors that affect prognosis and there is no evidence as to which relative factors of illness may have an impact on stroke onset time. As patients who experience stroke symptoms, and have knowledge of them, may be more motivated to attend hospital, this study focuses on such patients and any associated illness.…”

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

“…19 There are several emerging technologies such as telemedicine and mobile stroke treatment units that are being used to help address these disparities. 20 Studies have demonstrated that telemedicine in a stroke system of care plays a fundamental role in increasing the use of thrombolysis, bridging the geographical gaps in underserved areas, facilitating an accurate triage of stroke patients to the appropriate providers, and allowing rapid visualization and interpretation of neuroradiologic data. [52][53][54][55] However, in several states, Medicaid does not currently reimburse the provider for stroke telemedicine, 21 although, starting in 2021, Medicare will reimburse regardless of where the patient receives treatment.…”