Challenges Faced in the Treatment of Acute Ischemic Stroke

Leonard Yeo, Acting Neurologist, Ng Teng Fong General Hospital and Senior Consultant, National University Hospital’s Division of Neurology

A recent CERENOVUS study led by Leonard Yeo revealed that achieving first-pass success in mechanical thrombectomy improves functional outcomes for patients and lowers the cost of treating acute ischemic stroke in Asia Pacific. Against a backdrop of increasing burden of stroke, such findings provide healthcare professionals with an opportunity to advance the delivery of care.

A recent CERENOVUS study led by Leonard Yeo revealed that achieving first-pass success in mechanical thrombectomy improves functional outcomes for patients and lowers the cost of treating acute ischemic stroke in Asia Pacific. Against a backdrop of increasing burden of stroke, such findings provide healthcare professionals with an opportunity to advance the delivery of care.

1. How is the rising prevalence of stroke affecting healthcare systems in Asia-Pacific (APAC)?

More than 13 million people across the world face stroke every year. These numbers are only expected to increase – in fact as much as 34 per cent by the time we reach 2035. With APAC home to a majority of the world's population, countries in the region are experiencing a significant share in the burden – not just from a clinical perspective, but an economic one, as well.

Stroke-associated healthcare costs in select economies, including Thailand, China, Singapore and Australia, have reached as much as US$38.2 billion annually. Representing between 0.2 per cent and 2.6 per cent of their respective GDP, it’s clear that there is a significant financial impact, both on individuals and the healthcare systems in our region.

Now, more than ever, there’s a need for all healthcare professionals to explore how they can improve functional outcomes for stroke patients and ultimately reduce the substantial cost.

2. What types of surgical techniques are adopted in the treatment of stroke? What is an ideal outcome for surgeons in utilising such techniques?

For acute ischemic stroke, physicians generally seek to remove any obstructions and restore blood flow to the brain. Accordingly, mechanical thrombectomy by stent retriever or direct aspiration are increasingly adopted as primary treatment options with excellent evidence on their safety profile and utility.

An ideal outcome using these methods would be to achieve complete reperfusion in a single thrombectomy pass, also known as first-pass effect (FPE). There are several factors that can determine the success rate of FPE, ranging from the equipment available to the treating physician to clot composition in patients. However, several studies have shown that techniques incorporating balloon guide catheters and the combined use of stent retrievers and intermediate catheters at the beginning of the procedure can help to improve the rate of FPE.

3. How does achieving first-pass success in thrombectomy help improve functional outcomes for stroke patients?

Being able to achieve complete reperfusion in one pass can help to shorten the procedural time while reducing the risk of vessel injury and complications. With a growing body of data showing that achieving FPE can lead to favorable functional outcomes for patients, it has increasingly become an optimal goal for endovascular therapy in treating acute ischemic stroke.

4. What are the economic benefits of achieving first-pass effect to patients and healthcare systems?

I recently led a research project with CERENOVUS published in the Journal of Stroke , titled Health Economic Impact of First Pass Success: An Asia-Pacific Cost Analysis of the ARISE II Study. In the study, we evaluated the economic impact of FPE in the region, enabling us to ascertain the positive impact that first-pass success can have on improving patient outcomes and reducing economic costs. We concluded that patients who achieved FPE were discharged earlier, with their length of stay reduced by 3.38 days. Furthermore, fewer devices were needed during the procedure. Together, these factors caused acute episode costs to fall by nearly a third across all the countries studied, ranging from 32 per cent in Australia to 27 per cent in India.

Longer-term savings were also found to be largely driven by improvements in functional outcomes for patients achieving FPE. Reduced disability post stroke has been linked to lower use of healthcare resources, as well as lower costs for patients.

5. Are there any outcomes you hope to see in the delivery of care for stroke patients following publication of the findings?

Our study reinforced the value of FPE in improving both patient outcomes and healthcare resource utilisation. By lowering cost in the treatment of acute ischemic stroke in Asia Pacific, there is a ripple effect of positive benefit, cascading from the individual patient through to their healthcare systems.

When we can improve patient outcomes while reducing treatment costs, we have an opportunity to advance healthcare – for all critical stakeholders across the spectrum of care. That intersection of technology, procedural efficacy, and cost savings is truly where we can make a far-reaching impact.

--Issue 52--

Author Bio

Leonard Yeo

Leonard Yeo is a Senior Consultant at the Division of Neurology in the National University Hospital (NUH) and holds a joint academic position as Assistant Professor in the Yong Loo Lin School of Medicine. He is on the clinical competency committee for neurology training in NUH and serves as the section editor of the interventional neuroradiology journal. He is an author of over 130 peer-reviewed journal articles and over 80 conference presentations and book chapters. Outside of work, he volunteers as a doctor for HealthServe Clinics serving underprivileged foreign workers.

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