Making strides: Advances in stroke care innovation

Following his keynote fireside chat with Johnson and Johnson MedTech UK & Ireland at Med-Tech Innovation Expo 2023, Dr Paul Bhogal from Barts Health NHS Trust, shares more insight about the future of innovation in stroke care.

Let’s talk about the current innovations in stroke care. What’s really exciting you?

There are so many innovations coming in stroke care that it is hard to think of only a couple and perhaps the really exciting thing is how all of the small innovations will compound with one another. I feel that the ability to diagnose a stroke in an ambulance will make a big difference to stroke care. The earlier we can give clot busting drugs and get the patient to a centre capable of mechanical thrombectomy the better. The best way to do this is to diagnose patients in the ambulance and redirect the ambulance to the appropriate hospital rather than the nearest hospital. I am working with a company that is developing ‘helmet tech’ to make this possible. Similarly, I think we need to prevent strokes better. Intracranial atherosclerosis – narrowing of the arteries of the brain – is a massive global problem that is the leading cause of strokes. In many cases if this were treated early it would not result in a stroke and so it is imperative to develop the right technology to manage this condition. Finally, I think novel drug candidates will help not only protect the brain may also result in better prevention of strokes and so all of these things may intersect to make the risk of a debilitating stroke decrease significantly in the coming years.

At Med-Tech Innovation Expo, you spoke about stents that could remove clots. How big a step forward was this in stroke care?

The development of the appropriate technologies and techniques was perhaps one of the biggest steps. Prior to the use of stent-retrievers other devices existed and although these did the job they were of a sub-optimal design. The use of stent-retrievers was a game-changer and really heralded the transformation in stroke care that we have seen since they were first used. Although the original devices were never intended to remove clots from the brain I am privileged to have worked with, and have as a friend and mentor, probably the first person in the world to remove a clot using a stent-retriever - Prof Hans Henkes. Since the first pioneers started this technique there have been lots of device and technique innovations that now mean we can successfully remove the clot in over 90% of people and with a very favourable risk profile. In fact, the main risk from the procedure is failing to remove the clot but further work is being conducted all the time and we are confident that our success rates will continue to improve.

You also mentioned the role of AI in stroke care. Can you give us a little insight as to how it’s helped technology evolve in this area?

This technology has been a game-changer and I believe it will continue to offer new advantages to stroke clinicians and interventional neuroradiologists. 

When dealing with a stroke every minute is important and so speed is of the essence. Getting the patient to a centre capable of performing mechanical thrombectomy as fast as possible therefore becomes essential so that we can save as much brain as possible and increase the likelihood of a good outcome. In this regard Brainomix has been incredible – the fact that I can access the images performed at a hospital 100 miles away within seconds means complex treatment decisions can be made rapidly and the patients can get transferred to us rapidly. Being able to access those images on our phones, iPads, or laptops means that we can make these decisions anytime and anywhere. We have already shown this is speeding up the treatment pathway and this will have a beneficial outcome for patients in the long run. 

You also mentioned pulmonary thrombectomy – the same as with stroke but in the lungs – how much do you think innovators and treatment pathways can learn from other areas of the sector?

Within modern medicine there are innumerable silos and whilst clinicians are great at sharing knowledge on individual patients, we perhaps are not so good at sharing expertise on processes, pathways, and patient flow. Meeting and sharing ideas with one another can help to change this. This is not restricted to clinicians – allied healthcare specialists, innovators working in the field of telemedicine, AI, remote diagnostics etc. must also play a pivotal role in modern medicine – we all see different facets of the same problem. 

As with all people we can often be blind or simply unaware of new solutions to age old problems. We should try to forget phrases such as ‘this is how it has always been done’ rather, we should ask questions such as ‘what would this look like if it were easy?’ These sorts of thoughts open our minds to new possibilities and new ways of working and collaborating sometimes with unimaginable results. This was part of the reason I founded the BRAIN Conference – so that people from a wide background could come and share their ideas and expertise with clinicians so that together we can push the boundaries of medicine safely and effectively.

Tell us why medtech innovators should come along to BRAIN? 

BRAIN is the pre-eminent conference for interventional neuroradiology, neurosurgery, and stroke in the UK and we have a global reputation as being one of the most innovative and forward-thinking conferences dealing with neurological problems. We have a faculty and speakers from across the globe and a worldwide audience that last year exceeded 5,000 people. The opportunities to meet leading clinicians and other innovators from around the world are unsurpassed. 

One of the most important differences for BRAIN is how the talks are structured. At BRAIN we focus on putting talks on a theme together so that it is easier for the attendees to see the connections and start to understand topics and ask probing and challenging questions. If you don’t understand a topic, how can you even hope to find novel solutions or even ask pertinent questions? This has already led to novel technologies and approached being developed and we are only at the start of the journey.

How was your Med-Tech Innovation Expo experience?

It was fantastic and I had several very interesting conversations following my talk. The audience was engaging and enthusiastic and open to challenging the status quo and looking for novel solutions to the various problems that exist within healthcare within the UK but also further afield. Meeting people from a huge variety of backgrounds is exciting and intellectually stimulating and I love seeing how different pieces of a puzzle can fit together. Sometimes this can be introducing two people and acting as the bridge and in other cases it can be developing my own ideas in partnership with engineers or translational scientists.