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Walter et al. Vessel Plus 2021;5:27 https://dx.doi.org/10.20517/2574-1209.2020.102 Page 7 of 10

Table 1. Novel stroke diagnostic tools for stroke diagnosis in the hyperacute phase

Device Mode of action/aim Evidence Pro/Cons Ref.

Lightweight CT scanner - Non-thermionic nanotube - No clinical data available - Detection of other [38]
technology brain diseases
- Differentiation of ischaemic vs. possible
haemorrhagic stroke vs. stroke - May be able to
mimic include perfusion
imaging
- Possibly more
expensive
Microwave technique - Detects dielectric contrast - Early clinical studies: area under the curve of 0.85-0.88 - Identification of [37]
between tissues (in stroke: - Phase II/III trial: “Mobile Microwave-based Diagnosis and Monitoring of Stroke: on stroke mimicking MODS trial: ClinicalTrials.gov
contrast between blood and the Road Towards Improved Stroke Triage and Care, Including Prehospital Initiation of diseases not possible Identifier: NCT04257149
grey and white matter) Thrombolytic Treatment,” currently recruiting, completion expected Feb 2022 - Low cost
- Differentiation of ischaemic vs. - No perfusion
haemorrhagic stroke imaging
Mobile transcranial - Ultrasound detection of - Sensitivity of 78% and specificity of 98% - No stand-alone [40-41]
ultrasound including robotics occlusion signal diagnostic tool
and artificial intelligence - Differentiation of large vessel
occlusion ischaemic stroke
Blood biomarker: glial - Blood point of care test - First results STROKECheck device (GFAP, RBP-4, NT-proBNP), Bio-FAST trial): 84% - Accuracy in early [42]
fibrillary acidic protein - Differentiation of ischaemic vs. of ischaemic stroke patients could be identified hours after symptom Bio-FAST trial: ClinicalTrials.gov
(GFAP), retinol binding haemorrhagic stroke (vs. stroke onset unclear Identifier: NCT04612218
protein (RBP-4) and NT- mimic)
4 - GFAP: meta-analysis (1297 participants) with sensitivity of 0.756 (95%CI: 0.630- [43]
proBNP
0.849), specificity of 0.945 (95%CI: 0.858-0.980), and subgroup time from symptom
onset to GFAP measurement of 0-60 (235 participants); sensitivity ranges from 0.00
(95%CI: 0.00-0.97) to 0.89 (95%CI: 0.65-0.99), and specificity from 0.94 (95%CI:
0.83-0.99) to 1.00 (95%CI: 0.83-1.00)

- GFAP + RBP-4: patients with ICH who had RBP4 < 48.75 microg/mL and GFAP > [44]
0.07 ng/mL: sensitivity = 32%, specificity = 100%
- Open label non-randomised, prospective, pre-hospital trial: “Prehospital Advanced Treat-NASPP: ClinicalTrials.gov
Diagnostics and Treatment of Acute Stroke” to define cut-off values for GFAP and Identifier:
RBP4 NCT03158259Formularende

MODS: Mobile Microwave-based Diagnosis and Monitoring of Stroke: on the Road Towards Improved Stroke Triage and Care, Including Prehospital Initiation of Thrombolytic Treatment; GFAP: glial fibrillary acidic
protein; RBP-4: retinol binding protein; NT-proBNP: N-terminal pro B-type natriuretic peptide; Treat-NASPP: Prehospital Advanced Diagnostics and Treatment of Acute Stroke.

If alternative therapeutic devices shall find a place in acute stroke diagnosis in future, it is likely that several different technologies will need to be combined to

allow a more precise diagnosis. However, all of these devices are likely to be small and light enough to be easily transported to acute stroke patients in rural and
remote areas, enabling faster diagnosis and timely initiation of treatment.