Focus On: Indian Stroke Care System - SLICE Worldwide 2022

Indian Stroke Ship is docked in SLICE 2022 Port: Do you know how far nowadays Indian stroke care system is developed?!

Every year, as we used to, SLICE in Montpellier, the French marvelous touristic coastal city, surprises the Worldwide stroke community with outstanding sessions either on educational or advanced levels. This year`s event was extra-special as SLICE, for the first time, focused on the Indian stroke experience through Focus on session.

Why India?

It is simple to answer. India holds a prominent worldwide demographic and strategic position. According to the official estimates, the population is estimated to be about 1.4 billion (nearly 15-18 percent of the world’s population). Additionally, the quantum leaps of Indian developments not only in medical field but also in various areas of knowledge throughout the last decade were internationally noticeable. Thus, SLICE`s curiosity was raised to discover what is going on regarding stroke environment in this part of the world.

What happens in India? Dr. Vipul Gupta narrates…

Dr. Vipul Gupta, chief of neurointerventional surgery department of Artemis Hospitals in Gurugram, India, enriched our Indian stroke protocol experience background through the SLICE`s platform (Focus on session). He fruitfully and in detail discussed the stroke workflow there through impressive real life case illustrations with breathtaking videos from his institute.

Dr. Vipul Gupta started with presenting a case of 56 years old male patient with sudden loss of speech with face, arm, and leg weakness. Patient `s colleagues brought him one hour after the attack (Transport time) to Dr. Gupta`s institute. The institute was well prepared on both personnel and equipment levels for the rescue. Furthermore, Dr. Gupta personally discussed the whole condition with patient`s accompany to do the thrombectomy as soon as possible after rapid accurate diagnosis of the left Internal carotid artery (ICA) territory affection through Computed tomography (CT) examination and National Institutes of Health Stroke Scale (NIHSS) of 18 assessment. Finally, Thrombectomy was performed using aspiration catheter and stent retriever which was followed by restoration of circulation and lost patient`s functional motor abilities.

How far nowadays is Indian Stroke care system developed? Dr. Vipul Gupta answers.

During case demonstration, discussion with audience turned into several variable ways highlighting points of strengths and weaknesses of nowadays stroke care system in India. Dr. Gupta said that currently Indian stroke system became well developed than before. The dedication of 24/7 Neurointerventional fellows with well-equipped units for rapid and easily accessed diagnosis and intervention was considered as cornerstone for advanced stroke care.

In addition, discussion with the relatives about all treatment options and supporting as much as possible with all aspects related to the procedures` costs regardless of patient`s financial capabilities or insurance coverage. Finally, an intravenous recombinant tissue plasminogen activator (r-tPA) is fully supported as immediate therapy for every stroke patient whenever indicated.

Unfortunately, sometimes wind blows counter to what the ship wants. What are the challenges which face the stroke care system in India?

Dr. Vipul Gupta continued to clarify multiple points concerning the stroke workflow obstacles. First, huge population and traffic jams are difficult factors to control. Absolutely, these factors affect the transport time to the stroke unit and lessen the chance of better stroke condition outcomes.

Moreover, the ambulance system is not well developed till now. It was sad but worth mentioning that insurance coverage sometimes cannot include the whole procedure`s costs especially if extra step or instrument is needed such as carotid stent during the operation. Without any doubt, that can put more pressure on the patient financially. In the end, the stroke unit service is not widely spread and available in all hospitals.

Hard efforts mixed with Courageous Ambitions and deep hopes … Dr. Vipul Gupta fights back through diversity of steps.

The thoughts of Dr. Gupta were clearly explained of how to deal with such challenges. The most unquestionably important step taken by him is to lead a prospective study of the Indian stroke experience to strongly draw attention to how essential this medical emergency is to be supported on scientifically proved basis. In addition, working on the governmental and insurance levels together to reach the highest fund limit possible for such field. After all, strongly supporting the improvement of ambulance and emergency systems and their availability will certainly contribute to remarkable jump of stroke system of care`s efficiency.

Is India the only country who faces challenges?! Answer is No!!! … Quick review about some examples from other parts of the world.

On one hand, many countries have already established their stroke workflow system, on the other hand, still other countries confront different levels of difficulties. Generally, there are a bunch of obstacles which affect the stroke care system anywhere in one way or another. They can be related to public awareness, rapid access to stroke care, availability of equipment, cost coverage, rehabilitation, community support and secondary prevention.

For instance, less public awareness and less ambulance services which causes late transport time in some African and Asian countries like Nigeria, Cameroon, Lebanon, Ghana…etc. Another example is lack of well-educated personnel and highly prepared stroke services in some Latin American countries such as Guatemala, Ecuador…etc. [1]. Eventually, it is significantly noteworthy and strongly recommended to have a look on the Georgian experience and how they developed their stroke system since 2014 through well organized program including all aspects of stroke system starting from widening public awareness till system of rehabilitation and secondary prevention [2].

In conclusion, Indian`s stroke experience is undoubtedly exciting to have a closer focus on it. It was interesting to widen our horizons on how they managed to develop their structure over the past years to reach the advanced stage they are at today. Although challenges and obstacles are still there on the way, but, like many countries, everything needs time and continuous hard efforts to reach the well-established system that serve efficiently this crucially needed medical emergency for all people`s standards equally.

Sources:

1- Pandian, J. D., Kalkonde, Y., Sebastian, I. A., Felix, C., Urimubenshi, G., & Bosch, J. (2020). Stroke systems of care in low-income and middle-income countries: challenges and opportunities. The Lancet, 396(10260), 1443-1451.

2- Katsarava, Z., Akhvlediani, T., Janelidze, T., Gudadze, T., Todua, M., Akhvlediani, K., ... & Tsiskaridze, A. (2022). Establishing stroke services in the Republic of Georgia. European Neurology, 85(1), 56-64.