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Human Innovation Can Save Millions of Lives
EVT Will Save Millions of Lives
There was the case of Kris Walterson, who experienced a severe ischemic stroke and was successfully treated with an endovascular thrombectomy (EVT). This treatment involves using a microcatheter to remove a blockage, usually a blood clot, from a blood vessel in the brain. Walterson’s stroke was caused by an M1 occlusion, which was confirmed with CT scans. Without this recently developed treatment, Walterson’s prognosis would have been very different. EVT has the potential to save millions of lives in the future by restoring blood flow to the brain and preventing the rapid death of affected brain cells.
After receiving an endovascular thrombectomy (EVT) treatment for his severe ischemic stroke, Kris Walterson made a quick recovery and was able to walk around the ward just a few days later. Without the treatment, he would have faced a prolonged hospital stay and a much-reduced quality of life. Stroke is a leading cause of death and disability around the world, and EVT has the potential to save millions of lives and prevent severe deficits that force loved ones to become full-time caregivers. EVT has been called one of the most important medical innovations of the past decade, with neurointerventionalists in the United States completing roughly 60,000 EVTs per year.
While EVT has been successful in clinical trials, its implementation on a larger scale is challenging as it requires specialized training and a rethinking of medical protocols. Let’s follow the work of Dr. Mayank Goyal, a neuroradiologist who was involved in early research into EVT and recounts his experience of successfully using a new device to remove a clot from a patient’s brain.
For centuries, there was little progress in treating strokes since Hippocrates first wrote about it 2,500 years ago. The first link between “apoplexy” and bleeding in the brain was made in the mid-1600s, and by the 18th and 19th centuries, the medical establishment was emphasizing prevention through the moderation of lifestyle risk factors. Gradually, in the 20th century, a picture of the various common causes of stroke was brought into focus. The first real treatment breakthrough came in 1995 with the arrival of thrombolytics, colloquially known as clot-busters, which were used to break down clots found in blood vessels.
The Solitaire stent was adapted by neurointerventionalists for use in EVT, which led medical-device manufacturers to design thrombectomy-specific versions. Dr. Goyal worked with the stroke team at Foothills to extract clots from eligible patients, and they conducted a successful clinical trial called ESCAPE that showed EVT more than doubles the odds of stroke patients returning to an independent life. EVT involves a series of quick steps performed by multiple medical response teams, which can make implementing it into standard clinical practice complex.
The success of endovascular thrombectomy (EVT) in treating stroke depends on quick identification and treatment, which requires community-wide training and coordination. The province of Alberta implemented a province-wide strategy called ERA to make EVT accessible to all residents, which involved updating the training of frontline paramedics to quickly identify potential EVT recipients in the field. Paramedics use a flow chart-like system to determine whether a patient should be considered for EVT and contact a specialized medical phone center for a three-way call with the stroke team at a comprehensive stroke center and the medical transport team. This model is beginning to spread to other parts of the world.
EVT is effective for 5-15% of stroke patients who are eligible for the procedure, but those who receive it tend to have more severe cases. Patients who would have previously been on life support or in the hospital for weeks can now walk out within days, while those with smaller or moderate strokes may stay longer. The article also describes the frenetic choreography of the stroke team when a suspected stroke patient arrives, bypassing usual emergency room triage procedures. The article includes a description of a patient who received EVT and was discharged within a few days, as well as other patients on the stroke ward with varying degrees of stroke damage.
The procedure involves accessing the blocked artery through a needle and catheter, and using a stent retriever to remove the clot. Studies have shown that EVT can improve outcomes for stroke patients, but it can take a long time for new treatments to become widely adopted in clinical practice. However, after the publication of several studies, the American Heart Association quickly updated their guidelines to recommend EVT for certain stroke patients.
The implementation of endovascular thrombectomy (EVT) as a treatment for ischemic stroke is facing challenges in various countries. In some densely populated urban areas, there is excessive coverage of EVT centers, while rural access is limited. In other parts of the world, physical infrastructure, staffing, and policymakers’ awareness about the benefits of EVT are the primary challenges. The global workforce of qualified neurointerventionalists is also limited, meeting around 15% of the potential demand for EVT. The group, Mission Thrombectomy 2020+, advocates a top-down approach to promote global EVT access, targeting policymakers, primarily in lower- and middle-income countries, with information about the benefits of EVT. Despite challenges, advocates believe that with the right stakeholders’ support, EVT could save millions of lives annually.
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Mechanical/Solar Engineer, Prof. Oku Singer
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