How to increase access to endovascular therapy

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How to increase access to endovascular therapy

One of the go-to therapies for acute stroke brought on by large-vessel obstruction is endovascular therapy. When the M1 segment (main trunk) of the middle cerebral artery or internal carotid artery is blocked1,2, imaging results show that the infarct area (also known as the ischemic core) is small, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value of at least 6 (range from 0 to 10, with lower values indicating greater infarct burden), or when these conditions exist. Endovascular Therapy in Lucknow

Endovascular therapy in India

Geo-mapping data modelling reveals that only roughly two-thirds population has access to a stroke center that can offer Endovascular Therapy in Lucknow in less than 60 minutes.

According to the model, adding endovascular treatment (EVT) capabilities to 50 important hospitals might increase the percentage of Indians who have 60 minutes or less to obtain EVT from 63% to 71%, helping 22 million people.

However, a different approach can offer a greater boost at a lesser price. Even if they are a little further away, emergency medical staff could choose to go to facilities with EVT capabilities instead of neighbouring stroke clinics without them. Amrou Sarraj, MD, director of the vascular neurology fellowship programme at the University of Texas, Houston, who presented the study at the International Stroke Conference supported by the American Heart Association, said that’s an option if the patient is clinically stable and if they can accurately diagnose the patient with a large vessel occlusion.


The primary goal of current stroke treatment protocols is to get the patient to the closest facility that can provide intravenous tissue plasminogen therapy. According to Dr. Deependra Pandey, the EVT procedure “should be the same.”

Taking patients to a hospital that doesn’t provide EVT can actually cause delays. Three hours can easily elapse between the time the hospital admits the patient, concludes that EVT therapy is necessary, and transfers the patient to another facility. That is merely a guess based on our experience. However, if the distance to the other hospital is only 15 miles, it can be reached quickly by car.


In clinical trials of endovascular therapy, patients with big infarctions (e.g., those with an ASPECTS value of 5) have typically been excluded or represented in small numbers, in part because of worries that bleeding will occur in the area of infarction following reperfusion. In patients with an ASPECTS score of 5 or below, endovascular therapy may be associated with better functional results and lower mortality after 90 days than medical care alone, according to a meta-analysis that included observational studies.

When the infarction is large, endovascular therapy for acute ischemic stroke is typically avoided, although there isn’t much research on how endovascular therapy combined with medical care compares to medical care alone for large strokes.



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