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LETTER TO THE EDITOR
Year : 2017  |  Volume : 20  |  Issue : 2  |  Page : 156
 

Turf wars in stroke medicine: Why should patients suffer


Department of Radiology (Neuroradiology), CMC, Ludhiana, Punjab, India

Date of Web Publication8-May-2017

Correspondence Address:
Shriram Varadharajan
Department of Radiology (Neuroradiology), CMC, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.205777

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How to cite this article:
Varadharajan S. Turf wars in stroke medicine: Why should patients suffer. Ann Indian Acad Neurol 2017;20:156

How to cite this URL:
Varadharajan S. Turf wars in stroke medicine: Why should patients suffer. Ann Indian Acad Neurol [serial online] 2017 [cited 2019 Oct 20];20:156. Available from: http://www.annalsofian.org/text.asp?2017/20/2/156/205777


Sir,

Stroke is an emerging epidemic and increasingly affecting the younger population. It has become the most common cause of mortality after coronary artery disease. It is also the leading cause of chronic adult disability. India is facing a stroke epidemic, and unless steps are taken immediately, we would lose considerable portion of our workforce to chronic disability leading to additional burden on the already frail economy. Although prevention with focus on control of vascular risk factors is ideal for long-term benefits, improvements in emergency management of acute stroke can help reduce long-term disability. Stroke centers are few, and thrombolysis rates in our country are quite dismal with shortage of trained stroke neurologists. Furthermore, higher centers capable of endovascular treatment cater to very few percentage of eligible population. For developing countries like India, efficient resource utilization is only way forward. To achieve this, allied specialists should come together to ensure optimal stroke management. General physicians need to be trained in thrombolysis and medical management of acute stroke. Existing cardiac catheterization laboratories need to be utilized for emergency endovascular stroke intervention. We cannot wait for next few years in the name of capacity building while patients with acute stroke who are potential candidates for medical or endovascular treatment are not provided evidence-based management. Hence, general public need to be made aware of potential benefits of getting treatment in time.

  1. Who will thrombolyse these patients?
    Most common point of contact for acute stroke patients are either general practitioners or emergency medicine physicians. Hence, they must be allowed to give intravenous thrombolysis following short-term certification course
  2. Do we need certified stroke centers as per ASA/AHA guidelines?
    In Indian context, it would require monumental financial costs to set up certified stroke centers across the country. Rather, it will be easier for smaller hospitals to associate with nearby scan centers for primary stroke care and higher institutes/corporate hospital chains to serve as advanced stroke centers
  3. What are minimum requirements for advanced endovascular treatment?
    Although biplane DSA is ideal, most stroke interventions require minimum of single plane with subtraction mode which is available in most of existing cardiac catheterization laboratories. Hence, company people should certify that their products (cardiac DSA laboratories) are stroke ready meaning they have necessary features to support stroke interventions
  4. Who should perform endovascular stroke interventions?
    Any specialist with experience in neurovascular interventions should be allowed to perform these using cardiac catheterization laboratories.



   Summary Top


  • Time has come for neurologists, general practitioners, and emergency physicians to arrive at consensus statement regarding training and certification for acute stroke care with particular emphasis on thrombolysis
  • Indian criteria for certifying medical centers as being adequate for primary and advanced stroke management need to be derived incorporating general government hospitals, private scan centers, and higher institutes
  • Allied specialists with experience in neurovascular interventions need to use existing cardiac catheterization laboratories to perform stroke interventions
  • General public need to be made aware of the importance of reaching appropriate medical facilities in time for evidence-based care.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




 

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