Christopher Kellner, MD, Assistant Professor of Neurosurgery at Icahn School of Medicine at Mount Sinai, Director of the Inter-Subarachnoid Hemorrhage Program and a Cerebrovascular Neurosurgeon, talks about a new device that could help first responders quickly determine if a patient is having a severe or minor stroke.
Interview conducted by Ivanhoe Broadcast News in August 2017.
I want to start by asking you about VIPS and what it stands for?
Dr. Kellner: VIPS is Volumetric Integral Phase-shift Spectroscopy, and that is a device that uses bio-impedance to detect asymmetry from the right and the left side of the brain and that is able to differentiate between minor and severe strokes.
What is bio-impedance?
Dr. Kellner: Bio-impedance is the ability of tissue to conduct electricity and VIPS uses bio-impedance by admitting a variety of radio frequency waves through the brain and detecting how those waves have been modified by the tissue that it has passed through.
Why is it important to be able to pick up on the difference?
Dr. Kellner: That is a big deal because in the last few years we have developed the ability to treat a severe stroke, which is a blockage in one of the major arteries in the brain, by actually going inside the artery and pulling out the clot and only a few centers are able to do that. So if a patient goes to a center that does not have that capability, then they would have to be transferred to another center so this device might potentially be useful for an EMT to detect if a patient is having a severe stroke and they need to go to a stroke center with thrombectomy capability.
When you are talking about a severe stroke what are you talking about?
Dr. Kellner: A severe stroke is a complete blockage of one of the major arteries in the brain, and that causes symptoms like weakness and numbness on one side of the body and difficulty speaking.
You had mentioned that there is a specific procedure that only certain centers across the country are able to do, can you tell me again what that is called and what it involves?
Dr. Kellner: Thrombectomy is a procedure where a catheter is placed in the femoral artery and the catheter goes up all the way up to the clot in the artery in the brain and sucks or pulls out that clot.
When you talk about a minor stroke, what kind of symptoms are patients having?
Dr. Kellner: There are a wide variety of strokes, some are minor, and when you look at the arteries in the brain you do not see any blockage or you see a small blockage in an area that cannot be treated by a thrombectomy. A subset of strokes are treated by a thrombectomy and those patients benefit by going directly to a thrombectomy center.
If you go to the wrong center, what is the danger to the patient when there is that transfer and that loss of time?
Dr. Kellner: If a patient has a large vessel occlusion that can be treated with thrombectomy, it is best for them to go straight to a thrombectomy center or they could lose a few hours by going to a hospital that does not have that capability and time is grand and every minute counts in treating a patient with a stroke.
Talk to me a little bit about where you are in terms of testing this, are you in clinical trials for this?
Dr. Kellner: Yes, this device has been tested in the clinical trial and we are assessing how good the device is at telling the difference between minor and severe strokes, and we learned that it is extremely good with sensitivity of ninety two percent, which for example is better than an EKG is at telling when a patient is having a heart attack.
Is this a device that in the future you see that could be used similar in the way an EKG is?
Dr. Kellner: Definitely.
Could you tell me a little about that?
Dr. Kellner: This is very similar to how a EKG works or how an EKG would be used in the field to tell if a patient has a heart attack that can be treated in a center where they have interventional cardiology. The VIPS is kind of like an EKG for the brain, except it is much more accurate more than an EKG is; so it is an advanced EKG for the brain.
You have mentioned that the clinical trial is still ongoing, have you already finished phase one?
Dr. Kellner: We finished a first phase of the clinical trial, which is a derivation phase where we figure out how good this device is at telling if a patient is having a severe stroke and we were able to take away the algorithm the device uses to maximize its ability to detect a major stroke.
Does it need and phase 2 or a phase 3 testing?
Dr. Kellner: The next phase is to check to make sure that in a larger population of patients the data that we already have continues to stand.
I know it is hard to tell, but how long down the road could it be before this is a tool that you could use and the EMT’s could use?
Dr. Kellner: It could be in the next few years, the devices are already made and ready to go; it just takes a little bit more testing.
How does it work; from step one?
Dr. Kellner: The best way to use this device is if an EMT or a doctor, or somebody sees a patient who seems to be having a stroke; you take the device and it connects to your computer via Bluetooth and you position it on the patients head and wait five seconds. It gets a reading and shows you on the computer that it has received a reading and then you remove it, put it back on and you repeat that process and you get three readings. Then the device averages those three readings; so really it only takes 30 seconds to get a complete reading with the device.
What is the device reading for again?
Dr. Kellner: The device is checking bio-impedance through a range of radio frequencies and there is an audiometer and a receiver on the device. So it is comparing the right to the left side of the brain and when someone is having a severe stroke, often they have a blockage on one side or the other, and you can tell there is a big difference in the bio-impedance in that side of the brain compared to the other. The device is like a star trek visor and it has got an audiometer in the back of each side and a receiver in the front, so it will admit through the brain harmless radio waves and the detector will let can detect asymmetry between the bio-impedance in the right and left side.
Why are those asymmetries so important to pick up?
Dr. Kellner: The asymmetry is important because if someone is having a severe stroke they are going to have a blockage in one of their arteries supplying blood to one side or the other and the device can see that, if there is a blockage decreasing the amount of blood in one side versus the other.
Easy to use and painless to the patient?
Dr. Kellner: There is absolutely no pain or discomfort other than putting this visor on, but I think if someone is having a stroke it is not going to bother them at all; really it’s completely painless and has no risk.
Who would be the best candidates for this?
Dr. Kellner: At this point the best candidates and what we are testing it for are people who seem like they are having a stroke and we need to know if they are having a severe stroke or if they are having a minor stroke, or something else that looks like a stroke. It might be a seizure or a tumor, or something else that does not necessarily require a need to go to the thrombectomy center.
Does it matter if you are sitting, lying down?
Dr. Kellner: The device works best if the patient is lying flat on their back with their head slightly elevated and looking straight. Sometimes when a patient is having a stroke they are slumped over to the side, so the person using the device has to position them as much as possible.
How long does it take to get a reading?
Dr. Kellner: It takes 30 seconds to get a reading. You get three readings and those get averaged together and it takes 30 seconds for all three readings.
Anything else?
Dr. Kellner: One of the best things about the device is how easy to use it is and one of the problems with all of the neurological assessment tools we use and where we use different scales and do different neurological exams with patients; when they are in the ambulance or when they are in the emergency room, those have a lot of variability; but this is very simple. You put it on and press the button and it gives you a simple answer; yes or no at this point if the patient it having a severe stroke or not.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Christopher Kellner
Christopher.kellner@mountsinai.org
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
