Evaluation and implementation of new technologies directed at stroke constitute the second major activity of JTSSF. This occurs primarily but not exclusively on a research platform. Examples of technologies particularly relevant to JTSSF include new pharmaceuticals and devices for stroke treatment, as well as telecommunications and internet-based technologies, such as Smartphone and handheld digital device applications, videoconferencing and telemedicine.
Technological innovation can also be used to improve the efficiency and speed of treatment of stroke that is in progress (stroke in evolution). It is axiomatic that successful stroke treatment depends on these factors (“time is brain”). The rate of death of brain cells during a stroke has been quantified at approximately 2 million neurons per minute (Saver, J. 2009). Speed of intervention is also the primary determinant of whether modern drug therapy can be used for a stroke in progress: the only FDA-approved drug therapy for stroke, tissue plasminogen activator (tPA), must be given within 4.5 hours of stroke onset to minimize the potentially catastrophic risk of brain hemorrhage.
New technology has made stroke treatment possible, and this technology continues to improve. Technology also enables and enhances the systematic delivery and organization of treatment, making more rapid assessments and interventions possible for the stroke patient.
Nowhere in medicine is technology more advanced or more necessary than in stroke and cerebrovascular disease. The convergence of digital technology, neuroimaging and micromanufacturing has catapulted brain vascular technologies to the pinnacle of modern medicine. JTSSF is founded upon the principle that technology has become the most vital element underpinning the visualization, navigation and manipulation of the human brain, and is indispensable for the understanding and treatment of stroke syndromes.
Stroke Treatment: Internet Computer Technology
Time is brain, and the speed of stroke diagnosis and treatment is paramount in the outcome of the stroke patient. Computer technology and digital imaging are also applicable to the rapid treatment of stroke patients through Telemedicine. Digital information for a given stroke patient is transmitted by internet protocols to a treating physician in a Stroke Center hundreds of miles away. The patient can be examined as well as treated remotely, and critical time may be saved in making brain-saving and life-saving treatment decisions, like the administration of tPA. This kind of treatment is being actively developed and has made a critical difference in the approach to the stroke patient in the rural setting. Any patient can now be assessed as a neurological emergency. This capability is shaping the creation of networks of hospitals and physicians treating stroke patients, of ever-increasing sophistication, that culminate in the highly sophisticated and technologically advanced Comprehensive Stroke Center. Telecommunications technology can also be used to control robots capable of interacting with a patient, and allowing a detailed neurological examination. Consequently, research aimed at development and improvement of such capabilities is among the prime directives of JTSSF.
Emergency Stroke Treatment: Brain Surgery Without Opening the Skull
The first (and still only) drug approved for stroke was tPA, approved by the FDA in 1996. The availability of tPA provided a major foundation for emergency treatment of stroke. Endovascular neurological procedures, initiated in the 1960s and 1970s by neurosurgical pioneers like Luessenhop and Serbinenko, were greatly advanced by computer technology and digital imaging, which were in turn exponentially accelerated by the ever-improving computer chip in the 1980s and 1990s. By mid-1990s the technological revolution in Neurointerventional stroke treatments was well underway, with the development of the Guglielmi Detachable Coil for cerebral aneurysm treatment. Microcatheters for optimal intracranial navigation underwent continuous improvement, as did coils, and microguidewires for delivery through delicate, tortuous cerebral arteries were greatly improved by the development of hydrophilic materials, allowing them to be coated and to slip undetected through the vasculature with minimal disruption by clotting blood. These innovations continue to evolve at a rapid pace from new coil technology for cerebral aneurysms (see video, above, of aneurysm coil embolization) to intracranial stents for complex manipulations of brain blood vessels. New devices are also under development for emergency revascularization of occluded cerebral arteries in acute stroke. All of these technologically advanced brain surgeries are administered through a tiny incision over the femoral artery in the leg, without opening the skull. Research supporting and enabling such technological advancement and innovation is among the major targets of JTSSF.