World Brain Day -July 22, 2022
By: Dr Vipul Gupta
Stroke is the second leading cause of death and the leading cause of long-term disability. Although prompt treatment can greatly reduce the damage caused, it is important that patients recognize early symptoms and get to the hospital quickly.
When it comes to stroke, every minute counts. During every minute, 2 million cells die. In a way, during a stroke, the patient continues to lose a part of himself with each passing minute.
It is estimated that every 40 seconds someone suffers a stroke and someone dies from it every four minutes worldwide. While 25% of the population will suffer a stroke at some point in their life, physical activity is one of the best ways to prevent a stroke. People should be aware that an active lifestyle has many health benefits, including stroke prevention.
Every year, about 16 Lakh Indians suffer from a stroke, with a mortality rate of over 6 lakhs, and of those who survive, about 45% of them face severe permanent impairment. One in four adults has a lifetime risk of having a stroke. Even though stroke is known as a disease of the elderly and the risk doubles with age, more than 20-30% of all stroke cases in India occur in people under 45 years of age.
Nowadays we have modern stroke treatment methods in which very early treatment can stop the stroke in its tracks and can even reverse it. However, to be effective, it must be treated within the first golden hours after a stroke. The neuro-interventional procedure of mechanical thrombectomy has become the primary treatment for acute stroke. Large blood vessels that are blocked by a clot can be opened by this procedure which can help many patients miraculously recover.
However, few hospitals have a dedicated team of neuro-interventionists capable of performing this procedure as soon as a patient arrives at the hospital. To solve the problem, the “drip and vessel” approach is used to manage these patients.
In the peripheral hospital, the clot dissolving injection is administered (called -DRIP) and then the patient is transferred to the stroke center (called -SHIP) to perform the mechanical thrombectomy procedure which is very effective in the occlusion of large blood vessels. Using this approach, the patient receives the drug intravenously without having to be transferred to another hospital. And they can receive the advanced treatment of mechanical thrombectomy at centers focused on advanced stroke management. However, this requires close coordination and cooperation between peripheral and central stroke teams. Artemis Agrim Institute of Neurosciences has developed a network of peripheral stroke centers that manage stroke patients in close coordination with each other.
As soon as stroke patients arrive and the diagnosis is made by CT scan or MRI, the images are transferred to the Artemis stroke-neurointervention team who then coordinate the injection of clot-dissolving drugs, followed by a transfer to Artemis Hospital for mechanical thrombectomy. Since the Artemis stroke team has already seen the images and knows the patient’s condition and other medical details, they are able to very quickly transfer the patient from the ER to Artemis to the response lab and get the vessels reopened as soon as possible.
The “Drip and Ship” method is especially important in a country like ours where state-of-the-art facilities are not readily available, but coordination between outlying hospitals and larger hospitals can still help give the best possible treatment to these patients. In the stroke unit, a team of doctors including a neurointervention team is available 24 hours a day. For prompt treatment, teams of emergency physicians, stroke physicians, neurointervention and neurocritical care teams coordinate to perform emergency treatment within the first golden hours of a stroke.
The author is Head of Neurointervention and Co-Head of Stroke Unit at Artemis-Agrim Neuroscience Institute, Artemis Hospital