Pull the clot out - Reverse the stroke! | Sunday Observer
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Pull the clot out - Reverse the stroke!

31 October, 2021

Stroke advocates across the world including Sri Lanka  - Dr. Harsha Gunesekara (neurologist), Dr. Udaya K. Ranawaka (Neurologist) and Dr. Prasad De Silva (Radiologist) to mention a few, have  capitalised on World Stroke Day, calling all Sri Lankans  to engage in  virtual collaboration around the globe to increase awareness around this disabling disease and change the paradigm of stroke being a death or disability life sentence to one of resilience, with early recognition of symptoms   and  treatment. For this, they have emphasised time was a critical factor.  

Explaining why time was so important to prevent brain damage following a stroke, they told the Sunday Observer, “Time is brain. The longer the brain lacks oxygen and nutrients carried by blood, the more devastating the effects of a stroke. We now have the technology to extract a clot from an artery and restore blood flow to the brain within a limited time. But there has to be more awareness raising of its availability among patients.”

They said that since the early 2000s, a clot busting medication has existed to dissolve brain clots. “However, patients needed to be treated within a 4.5-hour window. In 2015, new guidelines supported the use of mechanical thrombectomy where a device is used to extract a clot from an artery and restore blood flow to the brain.

This technology can be used up to 24 hours from when stroke symptoms start. Though limited, we have capability to treat patients in Sri Lanka, yet recognition of stroke and triage to treatment is still a major issue and simply put, patients are not getting treated,” they told Medi Snips.

Consultant Neurologist Dr Harsha Gunesekera backed this argument by quoting one of the world’s leading stroke champions and the chair of a global initiative, Mission Thrombectomy 2020+ (MT 2020+), which seeks to increase life-saving treatment for stroke across the world, Dr Dilieep R. Yavagal. 

Reversible up to 24 hours

He said the latter who is an interventional neurologist at the University of Miami Miller School of Medicine in Florida, USA was up at 4 am in Florida, to keynote and rally top medical forces in Sri Lanka in a webinar to evaluate the possibilities to reverse strokes within 24 hours. “His message was that while stroke is now reversible up to 24 hours. That is the key message we need to spread across the world. Unfortunately, Dr Yugaval said that, “While that message appears so easy, it is the hardest to get out because we have had centuries of being not able to do anything for stroke and everybody just accepts it as a fate accompli.”  

Asked to share their experiences, the Lankan Neurologist participants at the webinar recalled the case of Ammi aged 56, who  they said, was a constant reminder to them of the devastating impacts of stroke due to her not being able to get timely treatment. “Mobilising her quickly to a hospital to get treatment, from her home in the depths of the rubber plantation, was a challenge.  Today, Ammi is chair and bed bound, paralysed from the waist down.”

On the up side, Radiologist Dr Prasad De Silva recalled a positive result due to the clot busting treatment reaching in time for a 56 year patient. “She was the first patient who received mechanical thrombectomy in 2018. Her stroke symptoms were recognised at 5:30am. She came to the nearest hospital and was triaged for mechanical thrombectomy at 8:30 am, by 10 am, her clot was removed. She regained full movement and speech. She walked home on day 3.”

Coordinated treatment

Asked whether Sri Lanka had possibilities of becoming a hub for creating a global and successful stroke campaign and  what  advantages we had over other countries, President, National Stroke Association of Sri Lanka, Dr Harsha Gunesekara cited Global initiative Chair Dr Yugaval as saying that the geography and small size of the country, lent itself to coordinated treatment if symptoms are recognised fast, while our  universal health care policy  and  the highly educated population provided a great base for a successful stroke awareness campaign.

On  how the collaborative effort benefits Sri Lanka, he said, “ Collaboration with MT2020+ allows Sri Lanka to take advantage of resources to assist with:  1  Physician training: remote proctorship so that neurologists in Sri Lanka can be trained in stroke treatment remotely. 2 Strengthening our triage systems: by educating our emergency medical services to recognise strokes in the field, and 3 Public Awareness: spreading the message that stroke is reversible up to 24 hours and teaching people the signs, symptoms and response needed for stroke.” 

Those interested in assisting with any of the outlined collaboration points can contact Dr. Harsha Gunesekara (Neurologist, President of the National Stroke Association of Sri Lanka; [email protected] and/or Zainab Magdon-Ismail ([email protected]).