Prime Time Living - Page 10 - RAPID data, rapid results

Prime Time Living
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RAPID data, rapid results
Technology allows doctors to see a stroke in real time

By Margit B. Weisgal, Contributing Writer

For years, doctors believed that there was an extremely short window to treat an ischemic stroke. Ischemic strokes are the most common and occur due to a blockage of blood flow to the brain. For acute ischemic strokes, those with a large blockage, a thrombectomy is performed, a mechanical intervention to remove the clot from the carotid artery to the brain.

An innovative technology, RAPID advanced imaging software, allowed doctors to see a stroke happening in real time. Since each person’s stroke grows at a different rate, it changed the time limit for receiving treatment.

Using CT scans and MRIs, the RAPID software platform, developed by stroke experts at Stanford Health Care, could identify regions of the brain with reduced blood flow and volume, predict parts of the brain with irreversible injury, and parts that could be saved. It’s the only imaging platform approved by the U.S. Food and Drug Administration for optimizing clot removal in stroke patients in the U.S.

With RAPID’s efficacy validated in 12 clinical trials showing patients successfully treated 24 hours after the stroke, the American Stroke Association, a division of the American Heart Association, changed its treatment guidelines from six hours, which caused many patients to be ineligible, to 24. This means doubling the number of patients who could be helped, which, in turn, had a huge impact on stroke care worldwide.

Dr. Greg Albers, professor of neurology at Stanford University, director of the Stanford Stroke Center and co-founder of iSchemaView (, the company that makes RAPID, says, “By building on the artificial intelligence and advanced imaging technology in RAPID, we will continue to contribute to increased treatment rates, which will lead to a major reduction in stroke disability and mortality.”

Then, as part of a pilot program under the aegis of Maryland Institute for Emergency Medical Services Systems (MIEMSS), RAPID was first brought to Sinai Hospital, a LifeBridge Health Center, as part of a multidisciplinary effort involving radiology, neurology and neurosurgery. At Sinai, it was spearheaded by William W. Ashley, Jr., M.D., Ph.D., M.B.A., FAANS, director, Cerebrovascular, Endovascular, and Skull Base Neurosurgery, Department of Neurosurgery, and Chief, Division of Neurointerventional Radiology, Department of Radiology, The Sandra and Malcolm Berman Brain & Spine Institute at Sinai Hospital, Dr. Daniel J. Durand, chairman of Radiology for LifeBridge Health, and Adrian J. Goldszmidt, M.D., chief, Department of Neurology, Sinai Hospital.

Impressed with the results, “MIEMMS is working with other primary stroke centers to obtain new CT scanners and the RAPID software as part of its Office of Hospital Programs,” says Dr. Timothy Chizmar, Maryland State EMS Medical Director of MIEMMS. “We are working on regulations developed with input from all the primary stroke centers and anticipate that these regulations will be approved by mid-2020.”

“Everything to do with treating the brain is dependent on time,” explains Dr. Ashley. “I came from academia and knew Sinai had all the ingredients to move to the next level – techs, nursing and administrators – we were poised to take the next steps. And we did. But, in the end, it’s all about our patients and seeing them doing well.

“RAPID advanced imaging shows how much brain is left to save. Now we say, ‘This person had a stroke and the information is sent to our smartphones in a couple minutes.’ We can diagnose where the blockage is and what needs to be done so quickly – all in real time.” If a person has a stroke that’s caused by a large vessel occlusion (a blockage in the carotid artery), the patient has to go to a thrombectomy-capable center or comprehensive stoke center as those are the ones able to do the required procedure. There are four in our area: University of Maryland Medical Center, Johns Hopkins Bayview Medical Center, Johns Hopkins Hospital and Sinai Hospital.

Another improvement implemented in conjunction with MIEMSS is to have the EMS team call and talk with the destination hospital while they’re on the way.

With earlier information, the hospital team is better prepared and can assess the patient more quickly.

We don’t often get to see life-changing breakthroughs such as this. Its impact goes beyond the treatment of ischemic stroke. It allows people who couldn’t be helped before to not only survive but recover. Stroke is the fifth leading cause of death. Maybe this will help reduce that number. •