Mumbai: Dr Sharath Kumar GG, Senior Consultant Neurointerventional Radiologist, Apollo Hospitals, Bengaluru interacted with ETHealthworld’s Prabhat Prakash on the advances in stroke management with the implementation of Artificial Intelligence (AI) and machine learning, the importance of the golden hour in stroke treatment and the major contributing factors to the increasing incidence of stoke amongst young Indian adults.

What are the major factors contributing to the 20 per cent increase in stroke cases among young adults in India? What financial ramifications result from the increasing number of stroke cases in India, namely in terms of missed wages, decreased productivity, and the influence on social life?

The surge in stroke cases among India’s young adults by 20 per cent is a complex issue, with several factors at play. The primary contributors are lifestyle changes, such as the increased consumption of fast food leading to obesity, diabetes, and hypertension, as well as sedentary behaviour due to desk jobs and excessive screen time. Additionally, mental health concerns, including high stress levels linked to urban life and sleep disorders, also contribute significantly.

Furthermore, substance abuse, including high rates of smoking and alcohol consumption, along with misuse of drugs, increases the risk of strokes. Medical conditions, such as hypertension, poorly managed diabetes, and prevalent heart conditions, further elevate the stroke risk. Inherited factors and a family history of stroke or cardiovascular diseases also contribute to the stroke incidence.

Lack of awareness can lead to delayed diagnosis, while inadequate healthcare services, particularly in rural areas, can result in delayed access to emergency care. Therefore, accessibility to healthcare and awareness about symptoms also play a pivotal role.

When we look at the financial implications of this increasing trend, they are substantial. Missed wages owing to prolonged work absences can lead to a significant income loss, particularly for families reliant on a single earner. In severe cases, if the stroke results in permanent disability, it could lead to lifelong loss of earnings. The increase in stroke cases also affects overall workforce productivity, thereby impacting the economy. Frequent medical appointments, recovery periods, and a reduced capacity to work can result in higher rates of absenteeism.

The social impact is profound, with patients grappling with high medical expenses for treatment, rehabilitation, and long-term care. The dependency on family members for care and support can increase psychosocial stress for both the patient and their caregivers. The patient’s social life can be drastically altered, leading to isolation, depression, and reduced social interactions and activities. To address this significant public health issue, comprehensive strategies are required. This includes lifestyle modifications, improved healthcare access, and increased public awareness and education about prevention and early detection.

Could you elaborate on the significance of the ‘golden hour’ in the treatment of strokes and the procedures used to accomplish mechanical thrombectomy and stroke thrombolysis within the crucial time frames?

The ‘golden hour’ in stroke treatment refers to the first hour after stroke symptoms onset. This is a critical window during which immediate medical intervention can drastically improve the prognosis of stroke patients, minimise brain damage, enhance recovery outcomes, and reduce the risk of death.

During this ‘golden hour’, two key procedures can be undertaken – stroke thrombolysis and mechanical thrombectomy.

Stroke thrombolysis, or intravenous thrombolysis, involves the administration of a clot-dissolving medication, tissue plasminogen activator (tPA), given intravenously. The magic of tPA is in its ability to breakdown the blood clot that’s blocking the artery, thereby restoring blood flow to the brain. However, the effectiveness of tPA is highly dependent on the timing. It’s most effective when administered within 4.5 hours from the onset of symptoms, with the best outcomes typically seen when given within the first ‘golden’ hour. It’s important to note that not all stroke patients are eligible for tPA. There are specific criteria like the type of stroke (it’s only for ischemic strokes), the time window, and checking for contraindications like recent surgeries or bleeding disorders.

The second procedure is mechanical thrombectomy, a minimally invasive surgery. Here, a specialised device is used to physically remove the blood clot from the blocked artery. This procedure can ideally be performed within six hours of symptom onset, but in some cases, it can be extended up to 24 hours, based on the patient’s condition and the imaging results.

In essence, the ‘golden hour’ is a race against time, and these procedures are rungs on the ladder to recovery. The timely use of these treatments can save lives and reduce the long-term disability associated with strokes.

What changes in stroke care has technology brought about recently? Could you talk about how emergency stroke care and AI-based diagnosis can improve patient outcomes?

The role of technology in revolutionising stroke care is truly remarkable. At the heart of these advancements is artificial intelligence (AI). AI and machine learning algorithms have made it possible to analyse CT and MRI images much faster than human radiologists could. These advanced systems can identify signs of a stroke, differentiate between types of strokes, and detect smaller or less obvious abnormalities that might be missed by a human eye. Moreover, AI tools like Viz.ai and Aidoc are redefining stroke care by quickly interpreting imaging results and notifying specialists of potential stroke cases. This rapid assessment streamlines the decision-making process, enabling faster intervention.

In addition to AI, telemedicine, or telestroke services, have made a significant impact. Through remote consultations, telestroke networks connect local emergency departments with neurologists and stroke specialists via video conferencing. This means that even in rural or underserved areas, stroke patients can receive expert evaluation and treatment recommendations promptly. Pre-hospital telemedicine has also gained traction, with mobile units equipped with telemedicine capabilities enabling paramedics to connect with stroke specialists while enroute to the hospital.

Another promising area of advancement is in robotic and minimally invasive interventions. Enhanced design and functionality of thrombectomy devices have increased the success rates of mechanical clot removal procedures. Similarly, robot-assisted procedures provide enhanced precision and control during interventions, potentially improving outcomes in difficult cases. Enhanced Stroke Pathway Systems, including automated notification systems, are vital in stroke care. These systems can automatically alert stroke teams and prepare hospital resources as soon as a potential stroke patient is identified by EMS.

AI-driven predictive analytics have also made a positive impact. AI can analyse patient data and predict outcomes based on a multitude of variables, aiding in clinical decision-making and personalised treatment plans. AI can optimise triage processes by prioritising patients based on the severity of their condition and likelihood of benefiting from specific treatments. Automated systems help streamline workflows, reducing the critical ‘door-to-needle’ and ‘door-to-groin’ times, which are crucial metrics in stroke care effectiveness.

What are the essential elements of a multidisciplinary team and why is it so important to restore a stroke patient’s abilities to their pre-stroke state? What constitutes a complete stack stroke care programme, and how might it lessen the rising incidence of strokes in India?

A multidisciplinary team (MDT) in stroke care is critical as it unites a variety of specialists to cater to the complex needs of stroke patients. The primary goal is to restore a patient’s abilities as close as possible to their pre-stroke state, ultimately enhancing their quality of life and allowing them to reintegrate into society.

Key members of an MDT include a neurologist, overseeing patients’ medical treatment; nurses or stroke coordinators, ensuring adherence to treatment protocols; physical therapists, focusing on restoring movement and strength; occupational therapists, helping patients regain daily living skills; speech-language pathologists, addressing communication difficulties and swallowing disorders; dietitians or nutritionists, providing dietary plans to manage risk factors; psychologists or psychiatrists, managing emotional changes; social workers, assisting with discharge planning; and rehabilitation specialists, overseeing the comprehensive rehabilitation plan.

Restoring a stroke patient’s abilities is integral for several reasons. It improves the quality of life, provides functional independence, reduces direct and indirect costs associated with long-term disabilities and enhances the psychological well-being of the patient and their family.

A complete stroke care programme includes elements like prevention and awareness, acute stroke management, acute inpatient care, rehabilitative services, follow-up and long-term care, research and innovation, and policy and infrastructure support. Implementing such a comprehensive programme in India could significantly reduce stroke incidence by facilitating early detection and prevention, improving access to emergency care, offering robust rehabilitation services, increasing awareness, and ensuring integrated care models.

  • Published On Jun 26, 2024 at 05:23 PM IST

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