World Stroke Thrombectomy Day raises awareness of a game-changing treatment, mechanical Thrombectomy, that saves lives and decreases disability in people experiencing a stroke. The first World Stroke Thrombectomy Day was on May 15, 2021, and today, as the number of people suffering from death and disability related to stroke continues to rise, so too has the urgency of informing the public about MT.
Despite the tremendous impact MT can have on improving the quality of life after a stroke, most people either don’t know about this treatment or do not have access to MT. “World Stroke Thrombectomy Day, established by the Society of Vascular and Interventional Neurology’s Mission Thrombectomy, aims to raise awareness about thrombectomy surgery as a life-saving treatment for severe strokes and to encourage global action to improve emergency stroke treatment,” said Dr. Thanh Nguyen, President of the Society of Vascular and Interventional Neurology.
When I was a neurology resident, I cared for a large number of patients who were rendered paralyzed after suffering a stroke. They were typically unable to return to work and often confined to a nursing home and dependent on others for care. Treatments were limited. If patients got to the emergency room within the first 3 hours, we were able to treat them with a clot-busting medication known as a thrombolytic, which sometimes reversed the stroke. However, most patients did not make it to the hospital in time, so it was typically too late for them to get this treatment.
In 2015, there was a paradigm shift when MT became a treatment option for people suffering from a stroke. The first step is for the patient or loved one to recognize that their symptoms might be from a stroke. After symptom discovery, the patient must be taken to the nearest emergency room immediately. In the ER, scans of the brain and brain vessels will be performed to pinpoint the location of the clot. Specialists known as neurointerventionalists can thread a catheter into that region and remove the clot. This procedure can be done up to 24 hours after the stroke has started. In the ER, you can expect the doctors and medical team to be asking when the last time the patient was seen at their normal because that is the time used to start the 24-hour clock.
If a clot is identified and the patient was last normal less than 24hours ago, the team will plan for clot extraction. By removing the clot, blood flow gets restored to the brain, which means oxygen can be delivered, and brain cells salvaged. Initially this treatment was only being offered at large medical centers, which drastically limited the number of patients who could access this treatment.
“Decades ago, cardiologists were able to effectively bring cutting edge interventional treatments to their patients and save lives in acute heart attacks. Thrombectomy, only shown to be effective in the past 10 years, has ushered in a new era of stroke care,” said Dr. Adam Karp, a neurovascular fellow at Mount Sinai Medical Center. “We can now offer a much better outlook for some of our sickest patients. As we push the techniques further, we must focus on fine-tuning these pathways to make them more widely available to the community and enhance access so these life-saving procedures can be brought closer to home for patients in need,” added Dr. Karp.
It’s often said that it takes an average of 17 years for research to be adopted in clinical practice, though this timeline can vary significantly from case to case. The death and disability from stroke is so severe that we cannot afford to wait that long. This is why even some small community hospitals already offer this life-changing treatment.
Although efforts are underway to speed up the process of getting Thrombectomy into all communities, the disparity in access to Thrombectomy is striking. The median mechanical thrombectomy access, which measures the proportion of eligible patients who actually receive Thrombectomy, is only 2.79% and Black patients in the U.S. are less likely to receive this treatment than their White counterparts.
Furthermore, some countries have less than 1% access, including many without access. Low-income countries face 88% lower access than high-income countries, a 460-fold disparity. Factors influencing access include the country’s income level, prehospital stroke protocols, and the availability of mechanical thrombectomy operators and centers.
“To maximize reach and ensure widespread awareness, we launched our ‘Spread the Word’ campaign in multiple languages. By disseminating information in diverse languages, we aim to reach as many communities as possible, empowering individuals to recognize the signs of stroke and access life-saving treatment promptly,” said Dr. Fawaz Al-Mufti, Global Chair of Mission Thrombectomy, Associate Dean at New York Medical College, and interventional neurologist at Westchester Medical Center.
“Our goal at Mission Thrombectomy is to bridge these gaps and ensure that the benefits of endovascular thrombectomy reach patients worldwide without undue delay,” added Dr. Al-Mufti,
As the second leading cause of death and a leading cause of disability globally, the toll of stroke on human lives is immense. The World Health Organization estimates that by 2030, stroke will become the leading cause of disability worldwide. As part of the effort to raise awareness regarding thrombectomy, Dr. Al-Mufti will be speaking at World Health Assembly in Geneva, Switzerland later this month.
There is great excitement in the neurology community about these advances in stroke care. It is now essential to get the word out so we can change the course of how stroke impacts our communities. “In 2024, the paradigm has shifted: Stroke paralysis is now reversible within the critical first hours through swift intervention with Thrombectomy. Time is of the essence. Recognizing the signs of Stroke (BEFAST) empowers individuals to act swiftly,” says Dr. Dileep Yavagal, founder and chair emeritus of SVIN’s Mission thrombectomy.
It is a new day in stroke treatment, and everyone should be made aware of the availability of this life-changing treatment. Getting to the hospital as soon as you recognize the problem is key. More work will be needed to make this treatment available in low—and middle-income countries as well as medically disadvantaged regions of the United States.
