Safety and efficacy of a novel robotic transcranial doppler system in subarachnoid hemorrhage

Clare, Kevin; Stein, Alan; Damodara, Nitesh; Feldstein, Eric; Alshammari, Hussein; Ali, Syed; Kurian, Christeena; Rosenberg, Jon; Bauerschmidt, Andrew; Kaur, Gurmeen; Santarelli, Justin; Hamilton, Robert; Mayer, Stephan A.; Gandhi, Chirag D.; Al‐Mufti, Fawaz

doi:10.1038/s41598-021-04751-1

Cited by 17 publications

(8 citation statements)

References 20 publications

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“…Thorpe et al used TCD to recognize CBF waveform features (quantified as the velocity curvature index and velocity asymmetry index) that achieved good diagnostic accuracy for LVO. 43 Because the required technical expertise may limit broad implementation in the prehospital setting, Neural Analytics developed an autonomous system that obviates the need for an expert sonographer (NovaGuide™ TCD, Neural Analytics Inc, United States), 44 but its potential role as in detecting LVOs in clinical practice remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Portable Cerebral Blood Flow Monitor to Detect Large Vessel Occlusion in Suspected Stroke Patients

Favilla,

Baird,

Grama

et al. 2023

Preprint

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BackgroundEarly detection of large vessel occlusion (LVO) facilitates triage to a comprehensive or thrombectomy-capable stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales, however, are not sufficiently sensitive, so here we investigate the ability of the portable Openwater optical blood flow monitor to detect LVO in patients undergoing acute stroke evaluation.MethodsPatients were prospectively enrolled at two comprehensive stroke centers during acute stroke evaluation within 24 hours of symptom onset with NIHSS ≥2. Each patient underwent a 60-second bedside optical blood flow evaluation with the Openwater instrument. The Openwater instrument generates cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was deteremined based on CT angiographic imaging and defined as occlusion of the ICA, or first/second segment of the MCA. A deep learning model, based on a transformer architecture trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. ROC analysis compared the Openwater diagnostic performance (i.e., LVO detection) with performance of prehospital stroke scales.ResultsAmongst 135 patients, the median NIHSS was 8 (IQR: 4-14), and 52 (39%) had an anterior circulation LVO based on CT angiogram. The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The RACE scale had 60% sensitivity and 81% specificity. LAMS had 50% sensitivity and 81% specificity. In the ROC analysis, the binary Openwater classification (high-likelihood vs low-likelihood) had an AUC of 0.82 (95%CI: 0.75-0.88), which outperformed RACE (AUC: 0.70; 95%CI: 0.62-0.78; p=0.04) and LAMS (AUC: 0.65; 95% CI: 0.57-0.73; p=0.002).ConclusionsThe Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients who presented to the Emergency Department for acute stroke evaluation. These encouraging findings need to be validated in the prehospital environment.

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Section: Discussionmentioning

confidence: 99%

Portable Cerebral Blood Flow Monitor to Detect Large Vessel Occlusion in Suspected Stroke Patients

Favilla,

Baird,

Grama

et al. 2023

Preprint

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“…Emerging incorporation of point-of-care ultrasound in critical care now incorporating TCD may increase availability and expertise in its bedside application. Automated robotic TCD machines have the potential to allow continuous monitoring, allowing widespread use (30)(31)(32).…”

Section: Cerebral Blood Flowmentioning

confidence: 99%

Neuromonitoring in Critically Ill Patients

Rajagopalan

Sarwal

2023

Critical Care Medicine

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OBJECTIVES: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities. DATA SOURCES: English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL. STUDY SELECTION: Original research, review articles, commentaries, and guidelines. DATA EXTRACTION: Syntheses of data retrieved from relevant publications are summarized into a narrative review. DATA SYNTHESIS: A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients. CONCLUSIONS: Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.

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“…However, advances in robotic TCD technology may overcome the latter. 23,24 TCD is routinely used in neurocritical care to monitor for vasospasm in SAH patients and assess individual treatment responses. TCD measurements can guide the timing and the need for repeat endovascular interventions.…”

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

Precision Medicine in Neurocritical Care for Cerebrovascular Disease Cases

Petersen

Sheth

Jha

2023

Stroke

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Scientific advances have informed many aspects of acute stroke care but have also highlighted the complexity and heterogeneity of cerebrovascular diseases. While practice guidelines are essential in supporting the clinical decision-making process, they may not capture the nuances of individual cases. Personalized stroke care in ICU has traditionally relied on integrating clinical examinations, neuroimaging studies, and physiologic monitoring to develop a treatment plan tailored to the individual patient. However, to realize the potential of precision medicine in stroke, we need advances and evidence in several critical areas, including data capture, clinical phenotyping, serum biomarker development, neuromonitoring, and physiology-based treatment targets. Mathematical tools are being developed to analyze the multitude of data and provide clinicians with real-time information and personalized treatment targets for the critical care management of patients with cerebrovascular diseases. This review summarizes research advances in these areas and outlines principles for translating precision medicine into clinical practice.

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Safety and efficacy of a novel robotic transcranial doppler system in subarachnoid hemorrhage

Cited by 17 publications

References 20 publications

Portable Cerebral Blood Flow Monitor to Detect Large Vessel Occlusion in Suspected Stroke Patients

Portable Cerebral Blood Flow Monitor to Detect Large Vessel Occlusion in Suspected Stroke Patients

Neuromonitoring in Critically Ill Patients

Precision Medicine in Neurocritical Care for Cerebrovascular Disease Cases

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