Prehospital diagnosis of ischemic stroke (literature review)

DOI: https://doi.org/10.29296/25877305-2024-04-12
Issue: 
4
Year: 
2024

A. Baranova; E. Zmeeva; S. Yusufov; S. Mirzaeva
M.V. Lomonosov Moscow State University

Ischemic stroke is a major medical and social problem, as it is characterized by high rates of morbidity, disability and mortality. Non-invasive diagnostic methods, such as magnetic resonance and computed tomography, make it possible to visualize this pathology and, based on the results obtained, formulate a diagnosis in order to prescribe appropriate therapy for effective treatment and improve the prognosis of the disease. In recent years, the concept of prehospital diagnosis of ischemic stroke has been introduced, including mobile ultrasound machines for ultrasound examination of cerebral perfusion, as well as mobile stroke units (MSU). It was found that treatment in the MSU, including prehospital imaging, resulted in significantly better clinical outcomes, both because of early initiation of systemic thrombolysis in the golden hour and because of improved triage of patients for subsequent endovascular thrombectomy. Further financial and economic evaluation of mobile stroke units is needed, including the analysis of the cost-effectiveness of the investment project and the possibilities of introducing this innovative approach to stroke diagnosis and treatment in Russia.
Keywords: 
stroke
ischemic stroke
transient ischemic attack
magnetic resonance imaging
ultrasonography.

References: 
  1. World Health Organization. The top 10 causes of death. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death [Accessed 20 July, 2023].
  2. Kuriakose D., Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci. 2020; 21 (20): 7609. DOI: 10.3390/ijms21207609
  3. Пирадов М.А., Максимова М.Ю., Танашян М.М. Инсульт: пошаговая инструкция. Руководство для врачей. М: ГЭОТАР-Медиа, 2019; c. 272 [Piradov M.A., Maksimova M.Y., Tanashyan M.M. Stroke: step-by-step instruction. A guide for physicians. M: GEOTAR-Media, 2019; р. 272 (in Russ.)].
  4. Saver J. Time is brain – quantified. Stroke. 2006; 37 (1): 263–6. DOI: 10.1161/01.STR.0000196957.55928.ab
  5. Powers W., Rabinstein A., Ackerson T. et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49: e46–e110. DOI: 10.1161/STR.0000000000000158
  6. Audebert H., Fassbender K., Hussain M. et al. The PRE-hospital stroke treatment organization. Int J Stroke. 2017; 12 (9): 932–40. DOI: 10.1177/1747493017729268
  7. Kilic M., Scalzo F., Lyle C. et al. A mobile battery-powered brain perfusion ultrasound (BPU) device designed for prehospital stroke diagnosis: correlation to perfusion MRI in healthy volunteers. Neurol Res Pract. 2022; 4 (1): 13. DOI: 10.1186/s42466-022-00179-8
  8. Медико-демографические показатели Российской Федерации в 2012 году: Стат. справочник. М.: Минздрав России, 2013; с. 180 [Medical and Demographic Indicators of the Russian Federation in 2012: Stat. guide. Moscow: Ministry of Health of Russia, 2013; p. 180 (in Russ.)].
  9. Adams H., Bendixen B., Kappelle L. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24 (1): 35–41. DOI: 10.1161/01.str.24.1.35
  10. Клинические рекомендации «Ишемический инсульт и транзиторная ишемическая атака у взрослых». М.: Минздрав России, 2021; с. 260 [Clinical recommendations «Ischemic stroke and transient ischemic attack in adults». M.: Ministry of Health of Russia, 2021; p. 260 (in Russ.)].
  11. Валикова Т.А., Алифирова В.М. Инсульт: этиология, патогенез, классификация, клинические формы, лечение и профилактика. Томск: СибГМУ, 2003; c. 44 [Valikova T.A., Alifirova V.M. Stroke: etiology, pathogenesis, classification, clinical forms, treatment and prevention. Tomsk: SibGMU, 2003; p. 44 (in Russ.)].
  12. Hacke W., Kaste M., Bluhmki E. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359 (13): 1317–29. DOI: 10.1056/NEJMoa0804656
  13. Koga M., Arihiro S., Miyashita F. Factors associated with early recanalization failure following intravenous rt-PA therapy for ischemic stroke. Cerebrovasc Dis. 2013; 36 (4): 299–305. DOI: 10.1159/000355054
  14. Lansberg M., Straka M., Kemp S. et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012; 11 (10): 860–7. DOI: 10.1016/S1474-4422(12)70203-X
  15. Nogueira R., Jadhav A., Haussen D. et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018; 378 (1): 11–21. DOI: 10.1056/NEJMoa1706442
  16. Albers G., Marks M., Kemp S. et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018; 378 (8): 708–18. DOI: 10.1056/NEJMoa1713973
  17. Zhelev Z., Walker G., Henschke N. et al. Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack. Cochrane Database System Rev. 2019; 4: CD011427. DOI: 10.1002/14651858.CD011427.pub2
  18. Herzberg M., Boy S., Holscher T. et al. Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound. Crit Ultrasound J. 2014; 6: 3. DOI: 10.1186/2036-7902-6-3
  19. Kilic M., Wendl C., Wilfling S. et al. Acute Middle Cerebral Artery Occlusion Detection Using Mobile Non-Imaging Brain Perfusion Ultrasound-First Case. J Clin Med. 2022; 11 (12): 3384. DOI:10.3390/jcm11123384
  20. Wahlgren N., Ahmed N., Davalos A. et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): An observational study. Lancet. 2007; 369 (9558): 275–82. DOI: 10.1016/S0140-6736(07)60149-4
  21. Fonarow G., Smith E., Saver J. et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: Patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation. 2011; 123 (7): 750–8. DOI: 10.1161/CIRCULATIONAHA.110.974675
  22. Fassbender K., Walter S., Liu Y. et al. ‘‘Mobile stroke unit’’ for hyperacute stroke treatment. Stroke. 2003; 34 (6): e44. DOI: 10.1161/01.STR.0000075573.22885.3B
  23. Walter S., Kostopoulos P., Haass A. et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: A randomised controlled trial. Lancet Neurol. 2012; 11 (5): 397–404. DOI: 10.1016/S1474-4422(12)70057-1
  24. Ebinger M., Winter B., Wendt M. et al. Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: A randomized clinical trial. JAMA. 2014; 311 (16): 1622–31. DOI: 10.1001/jama.2014.2850
  25. Kunz A., Ebinger M., Geisler F. et al. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: An observational registry study. Lancet Neurol. 2016; 15 (10): 1035–43. DOI: 10.1016/S1474-4422(16)30129-6
  26. Kim J., Fonarow G., Smith E. et al. Treatment with TPA in the ‘‘Golden Hour’’ and the shape of the 4.5 hour time-benefit curve in the National US get with the guidelines-stroke population. Circulation. 2017; 135 (2): 128–39. DOI: 10.1161/CIRCULATIONAHA.116.023336
  27. Parker S., Bowry R., Wu T. et al. Establishing the first mobile stroke unit in the United States. Stroke. 2015; 46 (5): 1384–91. DOI: 10.1161/STROKEAHA.114.007993
  28. Wu T., Parker S., Jagolino A. et al. Telemedicine can replace the neurologist on a mobile stroke unit. Stroke. 2017; 48 (2): 493–6. DOI: 10.1161/STROKEAHA.116.015363
  29. Gutierrez J., Emery R., Parker S. et al. Radiation monitoring results from the first year of operation of a unique ambulance-based computed tomography unit for the improved diagnosis and treat- ment of stroke patients. Health Phys. 2016; 110 (5 Suppl 2): S73–S80. DOI: 10.1097/HP.0000000000000502
  30. Grotta J. BEST-MSU Study – Benefits of stroke treatment delivered by a mobile stroke unit compared to standard management by emergency medical services. Denver, Colorado: International Stroke Conference, 2021.
  31. Bache K., Grotta J. Improving stroke treatment and outcomes with mobile stroke units. JAMA. 2021; 325 (5): 441–2. DOI: 10.1001/jama.2020.25832
  32. Cerejo R., John S., Buletko A. et al. A mobile stroke treatment unit for field triage of patients for intraarterial revascularization therapy. J Neuroimaging. 2015; 25 (6): 940–9. DOI: 10.1111/jon.12276
  33. Kostopoulos P., Walter S., Haass A. et al. Mobile stroke unit for diagnosis-based triage of persons with suspected stroke. Neurology. 2012; 78 (23): 1849–52. DOI: 10.1212/WNL.0b013e318258f773
  34. Wendt M., Ebinger M., Kunz A. et al. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: Results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study. Stroke. 2015; 46 (3): 740–5. DOI: 10.1161/STROKEAHA.114.008159
  35. Gyrd-Hansen D., Olsen K., Bollweg K. et al. Cost-effectiveness estimate of prehospital thrombolysis: Results of the PHANTOM-S Study. Neurology. 2015; 84 (11): 1090–7. DOI: 10.1212/WNL.0000000000001366
  36. Koch P., Kunz A., Ebinger M. et al. Influence of distance to scene on time to thrombolysis in a specialized stroke ambulance. Stroke. 2016; 47 (8): 2136–40. DOI: 10.1161/STROKEAHA.116.013057
  37. Saver J., Goyal M., van der Lugt A. et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA. 2016; 316 (12): 1279–88. DOI: 10.1001/jama.2016.13647
  38. Perez de la Ossa N., Carrera D., Gorchs M. et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: The rapid arterial occlusion evaluation scale. Stroke. 2014; 45 (1): 87–91. DOI: 10.1161/STROKEAHA.113.003071
  39. Hastrup S., Damgaard D., Johnsen S. et al. Prehospital acute stroke severity scale to predict large artery occlusion: Design and comparison with other scales. Stroke. 2016; 47 (7): 1772–6. DOI: 10.1161/STROKEAHA.115.012482
  40. Ebinger M., Siegerink B., Kunz A. et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin. JAMA. 2021; 325 (5): 454–66. DOI: 10.1001/jama.2020.26345