By Daniel J. Durand
Chief Innovation Officer at LifeBridge Health
Newswise — While many of the speculative "AI" use cases within healthcare are either far-fetched or still many years away from touching patients, the stroke service line at LifeBridge Health (an alliance between Neurology, Neurosurgery, Emergency Medicine, and Radiology) has been on the forefront of using AI at the beside since late 2016.
Consider the following scenario, which recently occurred in our health system. A patient presented with left sided weakness to one of our community hospitals in the middle of the night on a weekend, exactly the kind of time when access to specialty care has historically been a challenge outside of major tertiary and quarternary stroke centers. He was seen briefly by the ER team before being immediately evaluated through a virtual "telestroke" consult by neurologist Dr. Richard Jung. The patient was judged to be highly suspicious for stroke and a RAPID scan was ordered. LifeBridge Health is still the only center in Maryland doing this, but the radiology departments at other health systems such as Johns Hopkins, MedStar and Maryland are now following in our footsteps and looking to implement similar programs.
The images above are from RAPID, a special kind of software that "processes" images from a CT scan of the head and uses a "deep learning" or "AI" algorithm to find parts of the brain that are not currently getting enough blood flow (green areas) as opposed to those parts of the brain that are already dead (pink areas). In the past, this kind of analysis often took technologists and radiologists over an hour to perform. With RAPID AI, we now get answers for patients and their doctors within minutes. In this case, the scan told us that large amounts of this patient's brain would die from his stroke if nothing was done to restore blood flow.
On this particular night, LifeBridge Health was also becoming one of the first health systems in the world to use IschemiaView's automated CT angiography AI algorithm (RAPID CTA AI). This technology uses AI to create pictures of the blood vessels within the brain to determine whether there are any large clots or blockages obstructing the flow of blood and causing the stroke. In our patient's case, the RAPID CTA showed that blood flow to one of the largest vessels in his brain was cut off by a large blood clot (the red region in picture below shows the area of absent blood flow).
Thanks to these two AI algorithms, our teams knew the following three things within minutes of our patient arriving in the ER:
- The patient's symptoms of left sided weakness were due to a large right-sided stroke.
- This was caused by a large blood clot in the right middle cerebral artery (MCA).
- Most of the patient's brain was still salvageable (not yet dead), meaning that he could still benefit from an emergent "thrombectomy" procedure to remove the clot.
The patient was emergently transferred to Sinai Hospital of Baltimore. Sinai is LifeBridge Health's flagship hospital, one of 26 Joint-Commission-Certified thrombectomy centers in the US, and home to The Sandra and Malcolm Berman Brain and Spine Institute which houses one of the largest neurointerventional radiology labs on the east coast. At Sinai, the patient quickly underwent thrombectomy at the hands of internationally-renowned neuroendovascular surgeon Dr. William Ashley. The results are shown clearly in Dr. Ashley's intraoperative images below.
This is what the patients brain circulation looked like in the OR before the clot was removed. Notice that there are no black lines (blood vessels) on the left-hand portion of the image - this is because the clot is blocking blood flow to that part of the brain at approximately the location shown by the red arrow where one of the blood vessels appears to end abruptly. If the clot is not removed immediately the patient will likely continue to have a large stroke with devastating consequences... he may even die.
Now look at the final image below, taken just moments after clot removal. The black dye is now coursing through many vessels that were previously cut-off. Notice the numerous new black squiggly lines in the red circle below, all of which were absent on the image above. This means that blood flow (and oxygen delivery) has been restored to all parts of the patient's brain. This means he has a great shot at surviving with his brain function and lifestyle intact - it really is that simple.
After the procedure, the patient's symptoms immediately began to resolve and he has since continued to enjoy an excellent recovery. He suffered a large stroke, but because the intervention was performed so quickly he is now currently expected to make a nearly a full recovery.
In the past, prior to RAPID AI, such patients could not have been treated as quickly or as aggressively. Because "time equals brain" in the golden hour of stroke, our ability to act quickly and with greater certainty means that there will be more lives saved and a higher quality of life for those who survive. Since we implemented the RAPID stroke imaging pathway at LifeBridge Health, we have quadrupled the number of live-saving thrombectomy procedures that we are able to offer patients in the Baltimore area. In a world where so much of the promise of AI seems like science fiction, real stroke patients, their families, and the city of Baltimore are benefiting tremendously from AI today.