Dr. Luciana Catanese, like many of us, typically begins her workday by checking her email. The morning of Dec. 9, 2020 was no different. The vascular neurologist started her shift at 8 am at Hamilton General Hospital (HGH) in Hamilton, Ontario, and was scrolling through emails on her mobile phone when she saw a new message that was particularly alarming: the CT perfusion imaging results of an acute ischemic stroke patient.
That patient, 50-year-old Leaha Beattie-Palmer, had arrived at another regional hospital in Kitchener, Ontario, only half an hour earlier. Because both hospitals are equipped with RapidAI imaging technology and are part of the same regional stroke network, Dr. Catanese was able to view Beattie-Palmer’s imaging results on her mobile device in real time. They revealed a large amount of tissue that could potentially be saved if quick action was taken to restore blood flow to the brain. The procedure to do that, endovascular thrombectomy (EVT), required the patient to be transferred to HGH.
“The images showed a very large mismatch volume, so I knew the patient was a potential candidate for EVT,” Dr. Catanese said. “I knew I didn’t want to waste any time, so I connected with the team in Kitchener immediately to get the patient’s clinical history.”
Hamilton General Hospital, operated by Hamilton Health Sciences, is the hub of the Central South Regional Stroke Network, which provides tertiary level stroke care to hospitals within the central south Ontario region. Around 150 thrombectomies are performed there each year on acute stroke patients from across the region. Typically, when a patient arrives with stroke symptoms, local hospitals in the network contact provincial telestroke services before connecting with the stroke team at HGH for consultation. In this case, however, through the use of the Rapid imaging platform, Dr. Catanese had immediate access to the patient’s images and was able to connect with the site before the initial telestroke consultation was even triggered.
“It allowed me to quickly obtain the required information from the referring site, initiate the transfer process and alert the EVT team,” Dr. Catanese said. “It really expedited our workflow. We saved 30 minutes if not more, which is critical since shorter treatment times translate into better functional outcomes for stroke patients.”
The stroke team at HGH didn’t waste any time. While Beattie-Palmer was being transferred, they began what Dr. Catanese described as a parallel workflow, preparing the angio suite and obtaining consent from the patient’s husband for the EVT procedure. They also obtained consent to enroll her in TIMELESS, a clinical trial evaluating the efficacy of the clot-busting drug Tenecteplase.
Upon arriving at HGH, Beattie-Palmer was re-scanned per hospital protocol. Her National Institutes of Health Stroke Scale (NIHSS) score, which had been 16 when she was first admitted, was now 20, indicating a potentially severe stroke. The TIMELESS study drug was administered to potentially help break up the clot prior to the procedure. In the angio suite, Dr. Bill Wang, the neurointerventionalist on call, performed the mechanical thrombectomy that successfully removed the main clot and restored blood flow to the patient’s brain, putting her on track to a nearly complete recovery.
“I think she had an excellent outcome. She regained full independence despite having a significant clot burden and also presenting a long time after she had been last seen well (about 12 hours),” Dr. Catanese said. “RapidAI allowed us to shorten our treatment time considerably, so I think it was highly effective in this case.”