Breaking new Frontiers

There are more than 56,000 Australians every year who experience a stroke and more than half a million people are living with the effects of stroke.

What is well-known is time matters, and the sooner a patient is connected with appropriate treatment in the "golden hour", the optimal window of time following a stroke, the better the outcome.

There are two main types of stroke, haemorrhagic and ischemic, and the treating team need to be able to confidently diagnose their patient to commence effective and safe treatment.

Current methods to effectively categorise the type of stroke a patient experienced involves a CT scan, which is heavy and expensive medical imaging equipment restricted to residing within the walls of a major hospital.

The radical and transformative research led by Professors Geoffrey Donnan and Stephen Davis, Department of Medicine and Radiology, Melbourne Brain Centre, The Royal Melbourne Hospital, is to take this technology directly to the patient.

"Stroke is a massive problem, it's the second most common cause of death in Australia and in Asia it's the most common cause of death," Professor Donnan said.

"You need an image to effectively manage a patient with appropriate therapies as this will tell you whether the stroke is due to a bleed or due to a blockage of the blood vessels," he said.

"You can't intervene unless you have this image because the interventions for a blockage are either a clot-dissolving agent, which would be lethal if given in the case of a bleed, or clot retrieval."

"We lose two million neurons every minute after a stroke occurs so every second of delay impacts upon a patients ability to recover."

The award of $1 M in funding from the MRFF Frontiers Stage One, one of only 10 projects awarded nationwide, will be utilised to develop lighter, cheaper and portable imaging equipment which is capable of being incorporated into a road and air ambulance.

"There have been major advances in recent years in terms of getting blood flow back into the brain with reperfusion therapy," Professor Davis said.

"If you live in central Melbourne, you have access to this treatment, but if you live in rural and regional Australia, you can't access these advances which have transformed stroke care," he said.

"The grant will transform equity and access to modern stroke care for all Australians, including Indigenous Australians."

Coupled with real-time data transmission capability, and a telemedicine network, this will allow first-responder healthcare professionals to seek expert support to ensure they optimise patient outcomes in the time-critical treating window.

"We can really make a difference and reach people in rural and remote locations and address the gap with Indigenous Australians with this technology," Professor Davis said.

"It's a blueprint for allowing these advances to be transported to all Australians and this is what wakes me up and keeps me going every morning," he said.

Stage One funding will explore the feasibility of this world-first initiative and build on the impressive pilot data collected as part the Melbourne Mobile Stroke Unit, the first mobile stroke unit in the country, based at the Royal Melbourne Hospital, which has been deployed to more than 2000 calls in the last 18 months.

"We are already making a huge difference in an urban setting, in a pilot scheme, with the Melbourne Mobile Stroke Unit." Professor Davis said.

"This Frontiers Stage One research is all about delivery, that is what is transformative, we already have the tools and we will develop more along the way, but this program is about delivering better patient outcomes," he said.

"It's about how we can transfer these treatment benefits experienced in an urban setting and make it accessible for all Australians to ensure health equity."

Commercial imaging partners, two are based in Australia (Queensland and South Australia) and one is an Australian division of a global company, will independently evolve their technology within the next 12 months.

"We are investing in Australian product development and disruptive technology," Professor Donnan said.

"Stroke is a condition that doesn't discriminate, although age is a risk-factor, it's preventable, beatable and treatable, but to do that you need to use modern therapy and technology," he said.

"This Frontiers Stage One will bring treatment to a patient's front door."

Delineating the clinical workflows and a detailed health economics analysis, as part of Stage One, will inform the business case for submission for Stage Two funding and implementation.