Development of Stroke Diagnostics and Therapeutic Methods

Stroke, or cerebrovascular accident, is one of the leading causes of death worldwide, and even among survivors, the vast majority suffer permanent health impairments. The severity of the disease is well demonstrated by the fact that in developed countries, it ranks as the second leading cause of death and the primary cause of disability.
One of the most important objectives of the Translational Neuroscience National Laboratory (TINL) is to improve stroke diagnostics and therapeutic methods and make them more widely accessible. Additionally, it is our important task to enhance public awareness related to the disease, as timely recognition of stroke can prevent severe complications.

Network Diagnostics
A major breakthrough in recent stroke treatment has been mechanical thrombectomy, which involves the removal of blood clots obstructing cerebral vessels. Successful interventions can significantly reduce or even entirely prevent the development of permanent health damage. However, time is a critical factor, requiring early symptom recognition, rapid diagnosis, optimal therapy determination, and prompt execution.
Before the establishment of TINL, the University of Pécs’s Imaging Clinic, Neurosurgery Clinic, the Pécs Diagnostic Center, and several county hospitals collaborated to create an artificial intelligence-based teleradiology network in the South Transdanubian region. This network dramatically improved patient survival and recovery chances by enabling timely, high-quality evaluation of imaging results and thus determining appropriate interventions.
As a continuation of this program within TINL, we have expanded the network with AI-supported evaluation of perfusion CT examinations, a crucial advancement in modern stroke diagnostics. This expansion allows new patient groups to benefit from cerebral blood flow restoration through thrombectomy.

Stroke Registry
Increasing the efficiency and cost-effectiveness of healthcare requires the structured, searchable, and analyzable collection of data. This is especially true for stroke care, where multiple parameters must be considered, and interventions must be performed within strict time limits. The organization of care can be assessed by knowing the time taken from stroke patient admission to the initiation of treatment.
Key information includes the quality of imaging, the proportion of treatments aimed at resolving vascular occlusion, the occurrence of related complications, and the outcomes of treated patients.
Within TINL, we have developed a stroke form system that allows structured data collection, which is essential for evaluating and improving the effectiveness of applied protocols. This form system, containing numerous parameters, is already being used by several of our partner institutions. Our goal is to further improve the quality of stroke care in Hungary by sharing the developed data recording method and involving more partners.
As part of the registry, we have also developed a form system for the structured data collection of hemorrhagic cerebrovascular accidents, which account for approximately 15-20% of stroke cases. This system will facilitate the development of a quality assurance framework for hemorrhagic stroke care. Implementing this at a national level could create a unique database on an international scale.

Application of CT Perfusion-Based Patient Selection in Acute Cerebral Circulatory Disorders Without Major Vessel Occlusion
While there are well-established clinical protocols for treating the most common cerebral occlusions, numerous clinical situations present with symptoms of acute cerebral circulatory disorders for which current guidelines recommend conservative management due to a lack of evidence for the effectiveness of proactive treatments.
If the legitimacy of vascular recanalization treatments could be demonstrated in these cases, many permanent health impairments could be prevented, which would significantly benefit patients, their families, and society as a whole.
By applying CT perfusion diagnostics during initial emergency care, we can select patients suitable for interventional treatment. Our clinical trials focus on three specific conditions:

1. Acute cerebral circulatory disorders caused by small vessel occlusion
2. Acute cerebral circulatory disorders caused by isolated internal carotid artery stenosis
3. Acute cerebral circulatory disorders resulting from isolated intracranial arterial stenosis
   We hope to demonstrate that acute endovascular treatment can be safely applied in these cases as well, leading to better outcomes than conservative management.

Diagnosis and Treatment of Hemorrhagic Complications
Procedures aimed at resolving cerebral vascular occlusions (thrombectomy and thrombolysis) can lead to bleeding at the affected areas, and diagnosing these hemorrhages remains a significant challenge. Detecting possible hemorrhages is crucial for subsequent patient management, as it involves preventing further vascular occlusions while avoiding extensive, destructive bleeding.
Our research aims to assess the effectiveness of different imaging techniques and examine the development of microbleeds after interventions, petechial hemorrhages in ischemic strokes, and clinical factors influencing hemorrhagic complications. Our goal is to significantly improve the recovery chances of stroke patients by efficiently identifying and reducing hemorrhagic complications.

Raising Public Awareness of Stroke
Time is the key factor in effective stroke treatment. Rapid diagnosis, followed by determining and implementing the appropriate therapeutic method, is vital to saving the patient's life and minimizing residual health damage. However, this not only depends on the efficiency of the healthcare system but also on public awareness.
To ensure that healthcare can fulfill its tasks, public awareness is essential, meaning that patients and their families must be knowledgeable about stroke symptoms and their importance.
The TINL stroke prevention program primarily aims to educate younger generations so that they can recognize clinical symptoms in their families, grandparents, parents, or older members of their communities and take appropriate measures. The Pécs Rotary Club and the Hungarian Rotary Clubs network are key partners in this program.