http://www.chicagotribune.com/bluesky/originals/ct-vassol-nova-brain-stroke-tech-bsi-20160314-story.html
A River Forest company's software is helping doctors determine whether a patient could have another stroke.
VasSol's Nova system works with MRI machines to provide a 360-degree model of a patient's vascular anatomy, with the ability to see blood flow in each vessel. It's being used in nearly 50 hospitals and imaging centers, including Northwestern Memorial Hospital and the University of Illinois at Chicago.
“It’s almost like if you put a radar gun on the street and a car is passing. You’re taking a slice of the speed as that car passes that point,” said Dr. Shyam Prabhakaran, associate professor at Northwestern University's Feinberg School of Medicine.
The software gives doctors a 3D glimpse inside a patient's blood vessels, showing volume, speed and direction of blood. The results help doctors decide if patients need treatment, either by medication or a procedure, VasSol CEO Chuck Doherty said. After treatment, they can be retested.
“We don’t have to perform brain surgery to check on this,” Doherty said.
The technology was developed in 1999 and received FDA approval in 2002.
The Nova technology was recently used during a six-year study of patients considered to be at risk of a recurrent stroke. Results of the blind, independent clinical trial, published in the February issue of JAMA Neurology, showed that patients who had a stroke in the back of their brains and who continued to have low blood flow in the area are at higher risk of a another stroke.
About a quarter of all 800,000 strokes in the U.S. each year are recurrent, according to the National Stroke Association website. Up to 80 percent of strokes are considered to be preventable with lifestyle changes and medical interventions.
The technology was commercialized by VasSol after being developed at UIC by Dr. Fady Charbel, a professor and head of the department of neurosurgery at UIC.
The company has also developed applications to measure blood-flow in vessels in the body — including in hands, lower extremities and kidneys.
Northwestern’s Prabhakaran said that he has studied blood flow and stroke risk prediction for 10 years, and that he is conducting a study using Nova and other technologies, which he expects will finish in 2019.
Prabhakaran said Nova helps physicians compare a patient’s blood flow statistics to those of a similar healthy person. Having that kind of information can help doctors determine whether a particular treatment or medication is having a positive effect.
The software “gives you a quantitative way to know that a treatment is actually working,” he said.
Dr. James Brorson, the medical director of the University of Chicago Medicine’s comprehensive stroke center, said the Nova scan can point out where the problem of low flow in patients, which can point to a higher risk of stroke.
Angioplasties or stent replacements can help blockages, Brorson said, but research hasn’t shown yet that those interventions are effective in lessening the risk of a stroke.
“Still, the information from Nova scanning might help in making these decisions, or in guiding how aggressively to apply standard medical treatments,” Brorson said.
mgraham@tribpub.com
VasSol's Nova system works with MRI machines to provide a 360-degree model of a patient's vascular anatomy, with the ability to see blood flow in each vessel. It's being used in nearly 50 hospitals and imaging centers, including Northwestern Memorial Hospital and the University of Illinois at Chicago.
“It’s almost like if you put a radar gun on the street and a car is passing. You’re taking a slice of the speed as that car passes that point,” said Dr. Shyam Prabhakaran, associate professor at Northwestern University's Feinberg School of Medicine.
The software gives doctors a 3D glimpse inside a patient's blood vessels, showing volume, speed and direction of blood. The results help doctors decide if patients need treatment, either by medication or a procedure, VasSol CEO Chuck Doherty said. After treatment, they can be retested.
“We don’t have to perform brain surgery to check on this,” Doherty said.
The technology was developed in 1999 and received FDA approval in 2002.
The Nova technology was recently used during a six-year study of patients considered to be at risk of a recurrent stroke. Results of the blind, independent clinical trial, published in the February issue of JAMA Neurology, showed that patients who had a stroke in the back of their brains and who continued to have low blood flow in the area are at higher risk of a another stroke.
About a quarter of all 800,000 strokes in the U.S. each year are recurrent, according to the National Stroke Association website. Up to 80 percent of strokes are considered to be preventable with lifestyle changes and medical interventions.
The technology was commercialized by VasSol after being developed at UIC by Dr. Fady Charbel, a professor and head of the department of neurosurgery at UIC.
The company has also developed applications to measure blood-flow in vessels in the body — including in hands, lower extremities and kidneys.
Northwestern’s Prabhakaran said that he has studied blood flow and stroke risk prediction for 10 years, and that he is conducting a study using Nova and other technologies, which he expects will finish in 2019.
Prabhakaran said Nova helps physicians compare a patient’s blood flow statistics to those of a similar healthy person. Having that kind of information can help doctors determine whether a particular treatment or medication is having a positive effect.
The software “gives you a quantitative way to know that a treatment is actually working,” he said.
Dr. James Brorson, the medical director of the University of Chicago Medicine’s comprehensive stroke center, said the Nova scan can point out where the problem of low flow in patients, which can point to a higher risk of stroke.
Angioplasties or stent replacements can help blockages, Brorson said, but research hasn’t shown yet that those interventions are effective in lessening the risk of a stroke.
“Still, the information from Nova scanning might help in making these decisions, or in guiding how aggressively to apply standard medical treatments,” Brorson said.
mgraham@tribpub.com
You are quite correct that the standard of care for treating ischemic stroke patients is not effective. The current system treats all stroke survivors the same way. With the NOVA® software described by Meg Graham in her Chicago Tribune article, we can segregate these patients into two categories of high and low risk. If universally adopted this would change stroke care dramatically.
ReplyDeleteIn the VERiTAS study, it was determined that patients who had suffered stroke but still had "Normal" blood flow (as determined using the NOVA® software") had only a 4% risk of recurrent stroke in the next 12 months. However, patentees with "Low" blood flow had a 22% risk! Low flow patients represent about 25% of all stroke patients.
Let me explain two very significant aspects of this re-categorization. First - on average stroke patients benefit from taking blood pressure reduction medication. So blood pressure reduction medication is a standard of care for stroke patients. However, VERiTAS demonstrated that the patients with the highest rate of recurrent stroke were patients who both had "Low" blood flow and who were given blood pressure reduction medication. Obviously this means that we should STOP giving blood pressure reduction medication to 25% of stroke patients. We are virtually poisoning these people. And, the ONLY way to know who has "Normal" and "Low"' blood flow is this simple NOVA scan.
Second, on average, the 12-month recurrent rate of stroke is 8.5%. The risks of most vascular and surgical procedures that might be available to these patients is probably greater than 8.5%. A couple of different clinical trials of varying procedures have probably averaged about 14% risk. So no one would perform a 14% risk surgery on a patient with an 8.5% risk of recurrent stroke. With NOVA, however, a physician can now determine the truly high-risk stroke patients - the 22% group. Now, it might make perfectly good sense to perform a vascular or surgical procedure on a patient with such high risk. At the University of Illinois at Chicago, they are already trying to save people in this group through various techniques. But most hospitals are still not even measuring blood flow.
In the current standard of care, a patient must have multiple strokes, and still be healthy enough for surgery before he/she is recommended for surgery. There are very few patients each year who can meet his standard.
So our current system gives medication to people who should not be taking it and refuses to perform potentially life-saving interventions on high-risk patients.
The good news is that this news is slowly filtering through the Neurology and Neurosurgical communities. Medical device companies are gearing up to produce new products for Low Flow patients. Medical societies are considering recommending NOVA for reimbursement from Medicare and Medicaid.
The bad news is that Radiology departments are still not truly aware of NOVA and they have the power of the budget over purchasing MRI-based technologies like NOVA. In the Affordable Care Act, a lot of budget cuts have come out of Radiology and they are unable to take the small risk of buying the NOVA software.
I encourage everyone in this blog to have their physician learn more about NOVA. The more demand we create, the more likely this critical diagnostic software will be made available to all stroke patients.
Chuck Doherty
CEO
VasSol Inc.
River Forest, IL