Blood Test for Strokes

Stroke is the leading cause of disability worldwide and the second leading cause of death. Early intervention can mitigate severe consequences, and a new diagnostic tool could significantly improve outcomes.

Researchers at Brigham and Women’s Hospital have developed a test that uses blood-based biomarkers and a clinical score to accurately identify patients with large vessel occlusion (LVO) strokes.

“We have developed an accessible tool that could help ensure more stroke patients receive timely, critical care,” said Joshua Bernstock, MD, PhD, a clinical fellow in the Department of Neurosurgery at the hospital.

Most strokes are ischemic, caused by obstructed blood flow to the brain. LVO strokes, a severe form of ischemic stroke, occur when a major brain artery is blocked. These require immediate treatment with mechanical thrombectomy, a procedure to remove the blockage, to prevent brain cell death and severe disability.

“Mechanical thrombectomy can restore patients to their pre-stroke condition,” explained Dr. Bernstock.

However, symptoms of brain bleeds can mimic those of LVO strokes, requiring different treatments. The new test distinguishes between the two conditions in the field.

The research team targeted two proteins in capillary blood: glial fibrillary acidic protein (GFAP), associated with brain bleeds and traumatic brain injury, and D-dimer. Their study demonstrated that combining these biomarkers with field assessment scores (stroke triage for emergency destination, or FAST-ED) can identify LVO strokes and rule out brain bleeds.

“The sooner this intervention occurs, the better the patient’s outcome,” said Bernstock. The study, published in the journal Stroke, showed that the test identified LVO strokes with 93% specificity and 81% sensitivity within six hours of symptom onset. It also ruled out all patients with brain bleeds.

This tool could be especially valuable in low- and middle-income countries where advanced imaging is unavailable. It might also aid in diagnosing traumatic brain injuries. The team is conducting a prospective trial to test the tool’s performance in ambulances and has designed an interventional trial to speed up stroke triage by bypassing standard imaging.

“In stroke care, time is brain,” Bernstock emphasized. “The sooner a patient is on the right care pathway, the better their outcome will be. Our prehospital diagnostic tool is set to be transformative.”

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