New fin­ger-prick test to save stroke pa­tients

Irish Daily Mail - - Good Health - By ROGER DOBSON

ANEW fin­ger-prick test could be a life­saver for stroke pa­tients as it dra­mat­i­cally cuts di­ag­no­sis time to un­der five min­utes.

By avoid­ing the need for time­con­sum­ing scans, it means treat­ment to re­duce per­ma­nent brain dam­age can be­gin ear­lier — ie, in the am­bu­lance be­fore the pa­tient ar­rives at hospi­tal.

The de­vice, which is sim­i­lar to those used by peo­ple with di­a­betes to check blood sugar lev­els, is be­ing tri­alled on 375 pa­tients in the UK and could be ap­proved for use in hos­pi­tals by early next year.

The blood test, SMARTChip, checks com­pounds called purines which are pro­duced by cells when de­prived of oxy­gen — as oc­curs in is­chaemic stroke, where clots stop the blood sup­ply.

Stroke is one of the most com­mon causes of death in Ire­land and one of the largest causes of dis­abil­ity, as the re­duc­tion of blood sup­ply and oxy­gen causes ir­repara­ble brain dam­age.

Roughly 85% of strokes are is­chaemic stroke: the re­main­der are hae­m­or­rhagic, caused by bleeds in the brain as a re­sult of a burst blood ves­sel.

Dur­ing the ini­tial stage of a stroke, ap­prox­i­mately two mil­lion brain cells die ev­ery minute, so the faster the oxy­gen sup­ply can be re­stored, the more of the brain can be saved.

One of the chal­lenges for doc­tors and paramedics is de­ter­min­ing the type of stroke and di­ag­nos­ing it, based on symp­toms which over­lap with other con­di­tions such as seizures or brain tu­mours.

Paramedics look for signs such as fa­cial droop­ing, arm weak­ness and speech dif­fi­cul­ties — but some­times other con­di­tions can be mis­taken for strokes, or real strokes may be missed.

Is­chaemic stroke is treated with clot-bust­ing drugs. If given in 30 min­utes, the chance of full re­cov­ery can be as high as 90%, but this falls to around 50% three hours later.

Hae­m­or­rhagic strokes are treated with drugs that al­low the blood to clot — so it’s crit­i­cal the type is de­ter­mined quickly to al­low ef­fec­tive treat­ment. Cur­rently, this in­volves a CT or MRI scan in hospi­tal, which can take hours, los­ing pre­cious time.

The new test, on trial at Univer­sity Hos­pi­tals Coven­try and War­wick­shire, Univer­sity Hos­pi­tals of North Mid­lands, and Sal­ford Royal, de­tects lev­els of purines fol­low­ing re­search that has shown there is a surge in these af­ter is­chaemic stroke.

If a stroke is sus­pected, a fin­ger­prick drop of blood from the pa­tient is added to a dis­pos­able strip, the size of an ice lolly stick. This is in­serted into a hand-held reader which dis­plays purine lev­els within three to five min­utes.

Early re­sults from the trial show much higher lev­els in is­chaemic stroke pa­tients com­pared to healthy peo­ple. They also show that the higher the level, the greater the amount of brain tis­sue af­fected by the stroke. These re­sults can be used to guide treat­ment.

‘Use of rapid blood tests to iden­tify pa­tients with stroke is a very im­por­tant and ex­cit­ing area of re­search, and the re­sults of this trial are awaited with keen in­ter­est by the stroke com­mu­nity,’ says Dr Richard Perry, a lead­ing con­sul­tant neu­rol­o­gist.

PURINE re­lease into blood seems a good po­ten­tial can­di­date for iden­ti­fy­ing an acute brain in­jury, but it’s un­clear if it can dis­tin­guish be­tween block­age and rup­ture of an artery as a cause, he adds.

‘These two types of stroke re­quire very dif­fer­ent treat­ment strate­gies, so dis­tin­guish­ing them early is an­other im­por­tant goal for blood biomarker stud­ies.’

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