When it comes to treating a stroke, experts say time loss equals brain loss. Matthew Kesinger, founder and CEO of Forest Devices Inc., developed a device entering clinical trials that aims to decrease time loss by diagnosing strokes faster and more accurately.
“With every minute of delay, it’s about 1.5 million neurons in the brain have died,” Kesinger said. “So if we wait 10 minutes, we’re talking 15 million neurons.”
Wait times are often longer, because only 1 in 7 hospitals across the country serve as stroke centers. When emergency personnel realize someone is having a stroke, they immediately take them to a stroke center.
“The problem is that about half of strokes are not identified until they get to the hospital,” Kesinger said. “And because there are so few stroke hospitals, if they don’t get to the right hospital first, they’re talking a two-to-three-hour or even longer delay for treatment.”
Kesinger said he first started thinking about stroke diagnosis while working on an ambulance in Boston when the crew failed to diagnose a stroke. Following that, he researched emergency medicine in Pittsburgh and saw that about 50 percent of stroke patients arrived at hospitals ill-equipped to care for them. Underdiagnosis, he discovered, was a national problem.
“About 20 percent of all strokes that we think are strokes, aren’t really strokes. They’re stroke mimics,” Kesinger said. “But on the other side we miss strokes a lot because they can present atypically.”
Strokes occur when blood clots lodge themselves in the brain, but depending on the area of the brain in which they occur, symptoms can differ. Kesinger said the man they misdiagnosed in Boston was speaking coherently.
During his last year of medical school, Kesinger said he was exposed to a lot of different technologies. He recognized that one particular technology could be retrofitted to identify strokes.
“Basically, it’s like an EKG for the brain,” Kesinger said.
The minute-long test requires attaching electrodes to the forehead and the back of the neck and provides a binary result telling providers whether or not the patient is having a stroke.
“This is going to be a differentiator,” Kesinger said. “So instead of taking a person in an ambulance to the closest hospital … if they’re having a stroke, I can take them to the right hospital.”
Pittsburgh sees a higher than normal number of strokes, which Kesinger attributed to an aging population. But the city has two comprehensive stroke centers — hospitals that are able to provide all treatments for stroke 24 hours a day — within the city limits.
Kesinger also added that the average age of people experiencing strokes is decreasing. Five years ago the average age was 69 or 70, now it’s 65.
“It’s likely partially due to our poorer lifestyle choices,” Kesinger said. “One hypothesis is poorer air quality.”
Pittsburgh Penguins defenseman Kris Letang suffered a stroke last year, but returned to the team this year and scored the series-winning goal in the Stanley Cup Final. Nine out of ten people live through strokes, Kesinger said, but about two-thirds develop disabilities. Age is a major factor.
“It is abnormal for someone of [Letang’s] age to have a stroke, and when they do if they have appropriate treatment, they have a very very good prognosis.”
There are also improvements in treatment. Until last year, there was only one treatment for stroke — a drug that dissolves blood clots which is only effective within three hours of onset. Last year, a new intervention was approved that pulls clots from the brain using a catheter.
“There aren’t very many hospitals in the country that do those procedures regularly, but they change people’s outcomes dramatically.”
Kesinger said his device, Alphastroke, could improve the rate of accurate diagnoses, especially in outpatient settings where nurses and doctors might not recognize strokes as quickly as those who work in emergency rooms.
“Our long-term goal is to put this in the hands of every emergency department, urgent care center and ambulance in the country,” Kesinger said.
More EP Archives can be heard here.