The New Standard of Care in Ischemic Stroke Treatment

Stroke remains a leading cause of death worldwide, claiming over 6.6 million lives annually. From 1990 to 2019, the absolute number of stroke-related deaths rose by 43% — reflecting the growing global burden here.

However, during the same period, age-standardized mortality rates actually fell by 36%, thanks to remarkable advancements in prevention and treatment.

The top-level numbers are clear — more timely and effective ischemic stroke treatment and management would mean millions of improved outcomes and saved lives, worldwide.

This week, lets explore the history of stroke care, the numbers behind stroke care, and the innovation driving the future of stroke management.

Brief Detour on Stroke Types

• Ischemic strokes occur when a blood clot blocks the blood flow to the brain. Brain tissue is prevented from getting oxygen and nutrients, causing cells to die.
• Hemorrhagic strokes occur when a blood vessel leaks or bursts and causes bleeding in the brain. The bleeding increases pressure on brain cells and causes severe damage to them.

There are deeper classifications of strokes. For example, the origin of the blood clot in an Ischemic stroke determines if it is a Thrombotic strokes, when a clot originates in an artery, or an Embolic stroke, when a clot originates elsewhere like the heart or neck.

Regardless of the classification and severity, all strokes can be potentially devastating.

Journey from Thrombolysis to Thrombectomy

During the late 20th century, intravenous thrombolysis using tissue plasminogen activator (tPA) emerged as the gold standard for treating acute ischemic stroke. Approved in 1996, tPA was groundbreaking, offering patients a real chance at recovery.

However, tPA was far from perfect.

Its use was significantly limited by a strict 4.5-hour administration time window, and multiple contraindications that left many patients ineligible.

In the few years that followed, catheter-based mechanical thrombectomy was introduced as a transformative alternative for stroke treatment. The procedure enables the removal of a clot directly from a blocked artery using stent retrievers or aspiration catheters.

Fast forward, and thrombectomy has widely become the standard of care for eligible patients with large vessel occlusions (LVOs). Some trials of thrombectomy demonstrate an extended treatment window up to 24 hours in select cases, and show significantly improved functional outcomes for patients.

Stroke Care by The Numbers

Leveraging data available in LSI 's Market Intelligence Platform, our analysts estimate that the global neurovascular devices market will reach $1.7B by 2024, and eclipse $2B in total product sales by 2028, as it grows at a CAGR of 5.1% over the 2023 to 2028 forecast period.

Recently-updated data in LSI's Global Surgical Procedure Volumes Database projects that approximately 168,000 ischemic stroke procedures will be performed in the U.S. in 2024, a fraction of the 700,000+ annual ischemic strokes.

Limited access to, and delayed arrival at, stroke-ready facilities remains a significant barrier for patients to access effective and timely treatment. More on that later.

Deeper procedure-level insights:

• Amongst the U.S. stroke procedures performed, Mechanical Thrombectomy is seeing increased adoption and projected to continue growing at a 4.0% CAGR (2023–2028).
• Neurovascular Stents, which can be placed in tandem with thrombectomy, are seeing even faster domestic growth, with U.S. volumes growing at a 6.4% CAGR (2023–2028).

Most importantly, outcomes for thrombectomy patients are relatively better, with 50%+ of thrombectomy patients achieving functional independence compared to 20–30% with thrombolysis alone.

While still common, tPA usage exhibits much slower growth due to limitations in eligibility and the rise of alternative therapies.

Trends Transforming Stroke Care

Innovation in this space can be summarized in three words:

Time is brain.

In stroke care, every minute counts in protecting and saving the brain.

Towards this end, innovations in stroke care reflect rapid evolution of devices and digital technologies, pharmaceuticals, and procedural strategies to enable faster, precision treatment and management.

• Imaging-Based Selection: Techniques like CT perfusion and diffusion-weighted MRI help clinicians identify salvageable brain tissue and expand treatment eligibility.
• Mobile Stroke Units (MSUs): Ambulances and mobile vehicles with CT scanners, stroke specialists, and other portable technologies reduce pre-hospital reduce delays and improve access to timely intervention.
• Next-Generation Thrombolytics: Faster, safer clot-dissolving agents that may extend time windows for administration are under investigation.
• AI-Driven Workflow Optimization: AI tools will help prioritize and streamline decision-making, accelerating clinical decisions and treatment delivery in emergencies.

The breadth and diversity of presentations and underlying causes of ischemic stroke demand a tailored approach to care. Improved technology and understanding of stroke pathology will allow for treatment aligned with personalized patient profiles.

• Timing: Patients that present early (<4.5 hours) may be candidates for thrombolysis, while patients with salvageable tissue beyond this window may benefit from thrombectomy.
• Stroke Subtype: Treatments may differ across stroke subtypes, ex. cardioembolic strokes versus those caused by large vessel atherosclerosis or small vessel disease.
• Patient Comorbidities: Conditions like atrial fibrillation, diabetes, and hypertension influence acute management and secondary prevention strategies.

Who is Moving Stroke Care Forward?

On the diagnostics side, Sense Neuro Diagnostics is leading the way in creating scalable technology to detect, measure and monitor the brain.

As CEO Geoffrey Klass frames the problem, there has historically not been technology to triage people effectively in the field or monitor their condition in the neuro ICU. And when "time is brain," these are people that need to receive treatment in minutes, not hours.

Enter Sense, and they're non-invasive technology aiming to enable rapid, comprehensive detection of stroke by subtype and traumatic brain injury (TBI), and enable continuous brain injury monitoring.

"We needed to build something where usage required no technical skills. With [our device], EMS personnel can get a patient, put [the device] on, and turn it on, and in less than five minutes know if that patient is having a stroke and, more importantly, what type of stroke it is." — Geoffrey Klass, CEO of Sense Neuro Diagnostics

You can view Sense's full presentation on "Non-Invasive Brain Scanners" and their Studio Interview from LSI USA '24 in the Resource Hub on our website.

By Sense's estimate, the burden of triage and treatment costs the U.S. healthcare system upwards of $300B per year. One major driver is the number of misdiagnosed patients in U.S. emergency rooms, estimated to be approximately 40,000 to 80,000 patients annually.

However, there's another, larger problem, domestic and global care — access. Less than 1 in 30 patients globally have access to any sort of imaging equipment.

In fact, Bernard Bendok, MD , the WIlliam J. and Charles H. Mayo Professor and Chair of Neurological Surgery, Mayo Clinic Arizona, estimates that 100 million Americans, (approximately 33% of the U.S. population) cannot access a stroke center within 60 minutes.

In a panel discussion at LSI USA '24 titled "Neuro-Innovation: How Can We Enable Better, Faster Intervention Globally?" (full recording available on our website), Dr. Bendock and Dr. Hunt Batjer, Professor Emeritus and former Chair of Neurological Surgery at UT Southwestern Medical Center , lamented the realities of stroke care in the U.S. and abroad, and detailed the novel solutions they're exploring to improve outcomes.

"We're exploring better devices to tell us what kind of care the patient needs, AI to make smart decisions on the fly, and telemedicine in the ambulance. If that can happen, we can extend our capabilities across Arizona, across the country, maybe even across the globe with tele-robotics. Last month, we navigated wires and catheters from Scottsdale to Zurich. It was almost faster than being in person. There's going to be very little distinction between physical and remote presence very soon." — Bernard Bendok, MD , Mayo Clinic Arizona

The telerobotics research they described was conducted alongside Nanoflex Robotics , a Switzerland-based robotics startup developing next-generation solutions for critical of endovascular interventions and steadily marching to their first in human trial after raising a Series A in Feb 2023 from Ascend Capital Partners and Europe-based family offices, including #LSIAlumni Kinled Holding Ltd and Mountain Labs AG.

Matt Curran, CEO of Nanoflex, presented the company's "Remote Robotic Solutions" at LSI USA '24, and the presentation is available on our website.

The endovascular robotics market is heating up. Earlier this year, XCath announced that it had completed a first-of-its-kind live trial for telerobotic stroke intervention between Abu Dhabi and South Korea. The clinicians were reportedly able to remove the blood clot in minutes with low latency and a reliable connection.

Eduardo F. , CEO of XCath , presented the company's "Next-Generation Endovascular Robotic System" at LSI Europe '24. You can view the full presentation on our website.

Remedy Robotics is taking a new approach in this space. In 2021, Remedy's technology was trialed by first-time users to perform successful animal procedures from as far as 8,000 miles away. However, the company claims to have since demonstrated fully autonomous endovascular navigation, and is now preparing for its first-in-human.

Remedy is a DCVC TechMed portfolio company, highlighted by Alan Cohen during his thesis-unveiling Keynote on "The TechMed Movement" at LSI Europe '24, available to revisit on our website. David Bell , Co-Founder and CEO of Remedy Robotics, will be speaking and sharing more at LSI USA '25 in Dana Point, California on March 17-21, 2025.

Ischemic stroke management has come a long way, but the mission remains the same: save lives, preserve brain function, and support recovery.

Unfortunately, demographic trends imply that the burden of stroke won't be slowing down anytime soon. As such, the clinical need for innovation solutions and the market opportunity could not be greater.

More From LSI Market Intelligence

• Want to connect with innovators building the future of stroke care (and investors in these companies) They will be at LSI USA '25 in Dana Point on March 17-21, 2025. Secure your spot today while space is available.
• Download the decks from our recent Cardiovascular Market Dive and Orthopedics Market Dive for free data and insights from our team. Have additional questions? We can help.
• We just released new, indication-specific package pricing for our Market Intelligence Platform. Looking for trusted, comprehensive market intel on Neuro, Ortho, Cardio, or another area? Get in touch today.

Until next week,

Henry Peck and Nick Talamantes

LSI Market Intelligence Platform

All data in this article is sourced from LSI's Market Intelligence Team