An interview with Prof. Yvo Roos, Neurologist at Amsterdam UMC

Professor Yvo Roos is Vice Head of Neurology at the Academic Medical Center, Amsterdam. He is a part of the MR CLEAN executive committee and has played a key role in bringing latest acute stroke advancements into the clinic. Professor Roos spoke to us about his experience in stroke care including how things have changed over the years with some reflection on his early memories of NICO.LAB.

What drives you in your neurology role?

My real drive is innovation. There are a lot of doctors developing new treatments, setting-up trials and performing research but there are fewer people bringing those new treatments to practice, to the patients. I think that you need both sorts of doctors. In my work and research, I try to do both. I want to be innovative, but also make sure patients receive the new treatment they deserve.

What stands out as the most important thing in stroke care for you?

The most important thing when looking at the outcome for stroke patients is to give the patient the best suitable  acute treatment, as fast as possible. Time is brain! 

In acute stroke care the first couple of hours are crucial. Rehabilitation after the acute phase is important but compared to the acute treatment effects it won’t make a huge difference. It’s sad but it’s the truth. To make a real difference to patients’ lives we need to act fast. Getting images from the primary stroke centers as quickly as possible, so we can look at whether this patient can benefit from thrombectomy treatment is an essential step in the acute treatment. 

How have things changed in stroke care since the MR CLEAN trial?

Well, since we proved the efficacy of Endovascular Treatment (EVT) in the MR CLEAN trial in 2015, a lot has changed. Endovascular Therapy is a treatment that involves a catheter being inserted into the blood vessels within the brain, where you actually remove the thrombus. Only so-called comprehensive stroke centers can  offer this type of treatment 24/7.. This means the initial CT imaging is often done in a so called primary stroke center, but if the patient is eligible for EVT, the intervention team in the comprehensive stroke center must be involved immediately and the patient and the scan results must go as quickly as possible to thiscenter. Organisation of hospitals in a stroke network and good communication between them is therefore more important than ever. 

How does this organisational change work for you at the AMC?

I remember years ago, we went to the department of radiology and of biomedical engineering and physics and we said ‘Please help us! We need a solution to get some images as quickly as possible from the regional hospitals to our comprehensive stroke center and maybe even better, we would like to have software which helps the doctors in regional hospitals to pick out the right patients to transfer the data to us.’

So it was the department of biomedical engineering and physics who started working on that software problem and then began the development of the system which evolved into StrokeViewer. It has been incredible seeing this develop from the breakthrough clinical trial back in 2014 to today. 

Now we are working with regional spoke hospitals where the AI function helps them to point the exact location of the thrombus and select suitable patients for transfer to us. They can thereafter send images immediately to us, as the nearest intervention center. It can sometimes be difficult to decide whether a patient has a Large Vessel Occlusion suitable for EVT so sharing the images means others can help make this decision. 

If the decision is made to transfer the patient and perform EVT, the Intervention Neuroradiologist can start thinking about how to set things up, way before the patient is arriving in our hospital. It is great being ahead of time!

I look forward to seeing how stroke care and NICO.LAB will continue to develop over the next 5 years.

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References:
Saver, 2006 – “Time is brain—quantified.” Stroke 37.1 (2006): 263-266
FDA K200873 – StrokeViewer LVO is approved as HALO under FDA submission number K200873
Girotra, Lekoubou et al. 2020 – “A contemporary and comprehensive analysis of the costs of stroke in the United States” Journal of Neurological Sciences, volume 410, 116643

Further reading