“We are no longer in the era where we are nihilistic about stroke […] you can fix a stroke and reverse paralysis if systems are in place.”

– Dr. Dileep Yavagal, Interventional Stroke Neurologist

INTRODUCTION

Every year, about 15 million people experience a stroke worldwide (World Health Organization, n.d.). Among them, 5 million lose their lives and another 5 million are left with long-term disabilities and health complications (World Health Organization, n.d.), including difficulty speaking, loss of bone density, memory problems, and brain swelling, among others (National Heart, Lung, and Blood Institute, n.d.). This makes strokes one of the leading causes of global death and disability.

Thanks to recent medical breakthroughs, strokes are more preventable and treatable now than ever before. But the global distribution of stroke intervention procedures is far from equal, leaving thousands needlessly vulnerable to long-term disability and death. To truly improve public health outcomes among those who suffer strokes, universal access to these life-saving technologies is a must.

In this blog post, we’ll be answering the following questions:

• What is a stroke and who is at risk?
• What is Mechanical Thrombectomy and how can it help stroke patients?
• What is Mission Thrombectomy 2020+?

What is a stroke and who is at risk?

Strokes occur when blood flow to the brain is disrupted, either due to a blood clot (in the case of ischaemic strokes) or a burst blood vessel (in the case of hemorrhagic strokes) (The National Health Service, 2019). This prevents oxygen and nutrients from reaching brain cells, which can cause them to die in a matter of minutes (National Heart, Lung, and Blood Institute, n.d.).

A stroke is a serious medical emergency that can lead to long-term disability or even death if not addressed right away. Individuals can use the acronym F.A.S.T. to quickly identify the key signs of a stroke:

• Face: is it drooping?
• Arms: can you raise both?
• Speech: is it slurred or jumbled?
• Time: call 911 right away if a stroke is suspected (Heart and Stroke Foundation, n.d.)

Several factors increase one’s risk of experiencing a stroke, including:

• Age: by the age of 55, the risk of suffering a stroke more than doubles every decade thereafter 
• Gender: while strokes occur more often in men, more women die from them on average
• Smoking: people who smoke are almost twice as likely to experience a stroke than non-smokers 
• High blood pressure: blood pressure of 140/90 or higher can damage blood vessels that supply blood to the brain (Johns Hopkins Medicine, 2022)
• Race: hypertension is disproportionately common among Black people, making them more likely to experience a stroke (Centers for Disease Control and Prevention, 2017)

Many people can reduce their risk by making some simple lifestyle changes. Maintaining a healthy diet high in fiber and low in saturated fat and sodium lowers blood cholesterol levels, decreasing the likelihood of experiencing a stroke (The National Health Service, 2019). Exercising regularly, quitting smoking, and avoiding excessive consumption of alcohol have also been shown to decrease risk (The National Health Service, 2019).

What is Mechanical Thrombectomy and how can it help stroke patients?

Even with strong risk-reduction efforts and education, thousands of people will still inevitably experience a stroke every year due to uncontrollable risk factors. But thanks to recent medical developments, strokes no longer have to be a death sentence or result in a life-altering disability.

In 2015, a new procedure called Mechanical Thrombectomy (MT) was shown to be effective at treating strokes caused by large vessel occlusions (LVOs) (The Society of Vascular and Interventional Neurology, 2020). LVO strokes are one of the most common forms of ischemic strokes and disproportionately contribute to permanent stroke-related disability due to the amount of brain tissue they damage (The Society of Vascular and Interventional Neurology, 2020). MT reduces this risk by inserting a catheter into a major blood vessel in the wrist or thigh, which is then used to remove the blood clot (The Society of Vascular and Interventional Neurology, 2020). 

The effects of this treatment are hugely significant. When used within 24 hours of stroke onset, MT reduces the rate of neurological disability by up to 60% (The Society of Vascular and Interventional Neurology, 2020). These procedures thus have the potential to save thousands of lives, so long as medical providers have the ability to administer them.

Unfortunately, most regions do not currently have MT treatments readily available. Most MT centers are located exclusively in highly-populated urban centers in high-income countries (The Society of Vascular and Interventional Neurology, 2020), meaning treatment reaches less than 10% of the individuals who could benefit from it (Newswire, 2020). Low- and middle-income countries, who shoulder a burden of care 4-5 times greater than that of the United States, are most acutely affected by this disparity (Newswire, 2020). This consequently results in thousands of preventable deaths every year. 

What is Mission Thrombectomy 2020+?

To advocate for increased access to MT procedures globally, members of The Society of Vascular and Interventional Neurology (SVIN) launched Mission Thrombectomy 2020+ (MT2020+) in 2016 (Newswire, 2020). The goal of the campaign is to raise awareness about the benefits of MT and double global access every two years (Newswire, 2020). 

According to Dr. Dileep Yavagal, an interventional stroke neurologist and the Chair of MT2020+, the campaign works with over 80 regional committees around the world to help health policymakers implement MT in their stroke care systems. Each region’s action plan is informed by several core recommendations and tailored to the unique needs of each individual community. Some recommended actions include:

1. Educating policymakers and community members about MT: public health leaders should develop stroke education programs that focus on identifying symptoms, treatment options, and seeking emergency care
2. Training medical professionals to deliver MT: emergency medical personnel should be trained on how to provide swift and efficient care to a stroke patient and partake in stroke education programs on a regular basis to keep skills up-to-date
3. Building community-based thrombectomy systems: increase funding for high-volume stroke centers, improve post-hospital care resources, and support stroke research 
4. Improving inter-hospital transfers for MT: update hospital triage protocols to quickly connect stroke patients with MTs and equip all stroke centers with MT capabilities to avoid unnecessary transfers (The Society of Vascular and Interventional Neurology, 2020).

So far, the global impact of MT2020+ has been significant. Between 2018 and 2020, the campaign exceeded its goal of doubling access to MT – jumping from about 100 000 to more than 202 000 procedures performed annually within just two years. If this rate is maintained, Dr. Yavagal predicts that MT could become accessible to 50% of eligible patients by 2030.

Conclusion

While strokes are one of the most common ailments worldwide, solutions are available to reduce their risk of causing death and disability. However, greater global access to these solutions is needed to improve stroke-related public health outcomes. In this blog post, we’ve discussed:

• the causes of a stroke and who is most likely to experience one;
• the life-saving potential of MTs;
• Mission Thrombectomy 2020+ and actions policymakers can take to increase community action on stroke prevention and treatment

Written by: Claire Borgaonkar, BPAPM (c)