The outcome of patients with acute ischemic stroke depends, on the one hand, on the fastest possible recognition of the symptoms and their transfer to the hospital, and on the other hand, their immediate investigation in the hospital, with the aim of confirming the existence of ischemia of the brain tissue and identifying the cause that causes In both these stages, the time is the most decisive prognostic factor because in every minute that the brain remains without blood supply almost 2 million cells die.

Thrombolysis and mechanical thrombectomyare the therapeutic options that have spectacularly improved the course of the disease in recent years. Regarding the safety of intravenous thrombolytic drugs, there is a time window of 4.5 hours from the onset of stroke symptoms to the initiation of their administration. The corresponding period of time for performing mechanical thrombectomy reaches 6 hours, provided that the occlusion of a major arterial branch of the brain has previously been confirmed by imaging. These strict time limits significantly limit the number of patients who could benefit from the above treatments. But there are many borderline cases, such as when the symptoms are detected when the patients wake up from their night’s sleep or when they themselves or their relatives are not able to inform us about the exact time of the episode. However, there are also cases of patients who, due to the construction of their vessels, have good collateral circulation and therefore present, even after more than 12 hours, brain tissue that has not been damaged and can be saved if the blood supply is immediately restored with the appropriate treatment .

So in such cases where a simple imaging test is not sufficient, the doctor’s experience plays an important role and time is pressing dramatically, exactly where the application of artificial intelligence can break the Gordian knot.

The key questions that arise in the first hours after the establishment of a stroke are whether there is acute ischemia and exactly what is its extent. Equally important is the answer to the question of whether there is still viable brain tissue, also known as the penumbra or twilight zone, which means that therapeutic intervention makes sense even after 4.5 and 6 hours, as well as in cases of unknown settling time of ischemia. Finally, confirmation of the presence of a thrombus causing occlusion of a large cerebral artery allows immediate mobilization of the mechanical thrombectomy team.

All the above questions are now answered modern applications of artificial intelligence. One of the most widely used such software systems internationally is Brainomix 360 https://www.brainomix.com/stroke/, which was recently installed in the CT and MRI Department of HYGEIA. Utilizing the data of a conventional CT scan of the brain with intravenous contrast administration, the Brainomix 360 provides the clinician with valuable information in just 3 minutes. Depicting with great precision both the area of ​​the ischemic infarct and the penumbra and reliably detecting the existence of a thrombus that blocks the blood supply to the brain, it is an excellent tool in the hands of the doctor who is called upon to make immediate decisions for the best possible treatment of patients with acute ischemic stroke episode.

In this way, it is certain that the number of patients treated with intravenous thrombolysis or mechanical thrombectomy will increase even outside the known time windows. But perhaps more important is the fact that with the help of artificial intelligence we will achieve the right choice of the right treatment for the right patient. In this way we will ensure not only greater safety, but also greater efficiency in the effort to limit acute ischemic brain damage.