MODERN RUSSIAN TECHNOLOGIES FOR PATIENTS WITH ACUTE CEREBRAL DISORDERS

Highlights

• For the first time in real-world clinical practice across several Russian regions, the high reproducibility and efficacy of the domestic Grasper stent-retriever for mechanical thrombectomy in stroke patients have been demonstrated.
• An unique routing ecosystem “UDAR” was developed, integrating the pre-hospital stage, “Tele-PVU” telemedicine support, and automated 5–7-minute express CT scan evaluation driven by artificial intelligence.
• The synergy of digital control and domestic medical devices enabled a 2.5-fold increase in mechanical thrombectomy volumes and reduced hospital mortality from ischemic stroke by 8.1%.

Aim. Analyze the results of the pilot project “UDAR” (Smile, Movement, Articulation, Solution) on reorganizing the routing of patients with acute cerebral blood circulation disorders (AHC) when using telemedicine in the territory of Primordia, to assess the effectiveness of modern methods of reperfusion using domestic stencil-reducers.

Methods. The total number of patients suspected stroke included in the study was 18500. All patients at the pre-hospital stage were examined by a paramedic/ doctor of the emergency medical team, who entered on the tablet into the program “UDAR” patient data, then information was sent to the questionnaire of the program “UDAR” with automatic notification of the control center on the basis of a regional vascular center (RVC). The on-duty neurologist of the RVC then analyzed the data and gave recommendations for further routing to the primary vascular unit (PVU) or RVC (with LAMS > 3 points). If necessary, the neurologist of the RVC could conduct a telemedicine consultation with the medical doctor of the emergency medical team by video call to clarify the neurological status of the patient. Upon arrival of the patient in the PVU and CT-study of the brain, data was loaded into “UDAR” program. Control center radiologist had access to the patient’s CT scans. The first series of images was processed by artificial intelligence (AI) with identification of areas of detected pathologies, determination of the extent of lesions, scoring according to the ASPECTS scale prepared by an X-ray report. The second series was a native CT image. Based on the results of the examinations, the neurologist decided to leave the patient in the PVU or transfer to the RVC for mechanical thrombosis extraction.

Results. During the lifetime of the project, there was an increase in the frequency of thrombolytic therapy (TLT) from 3.9% to 8.6% (by 4.6%), the number of mechanical thrombosis extractions increased by 1.5 times in 2022 compared to 2021 and 2.5 times in 2023 compared to 2021. Hospital mortality rates from ischaemic stroke in the Primorsky PVU have decreased from 21.7% in 2021 to 14.9% in 2022 and 13.6% in 2023.

Conclusion. According to the data obtained from the pilot project, it was found that it is advisable to scale its results to other regions of the country.

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