India is part of leading clinical trials for stroke medicines because of increase in patient load. To this end, the INSTRuCT Network of the ICMR has numerous hospitals to assist in the human studies. It provides treatment for acute stroke, its prevention, recovery and rehabilitation.
According to Dr. NK Venkataramana, founder-chairman & director, Brains Super Specialty Hospital, Bengaluru, stroke is a catastrophic condition. Though stroke is known for centuries, no major advancements came in and it remained as an irreversible condition. But the last three decades witnessed innovations to minimise the brain damage, thereby enabling recovery.
A gold standard treatment for stroke is mechanical thrombectomy which removes the blood clot with a special device. Advanced imaging techniques and development new devices call for the need to reduce the time from the onset of stroke symptoms to endovascular intervention which remains a crucial factor that decides the final recovery, he added.
On the occasion of the World Stroke Day observed annually on October 29, India accounts for around 1.18 million cases in a year. One in six persons suffers stroke in their lifetime and its prevalence rises to 1 in 4 people among the 40 years or above.
Dr Kranthi Mohan, junior consultant neurology, BGS Gleneagles Global Hospital, Bengaluru noted that stroke is now fourth leading cause of fatality after cardiovascular disease, COPD and diarrhea and fifth leading cause of disability after Road Traffic Accident, occupational injury, falls and musculoskeletal problems. The incidence of stroke among youngsters increased especially during the Covid-19 pandemic.
Endovascular therapy with mechanical thrombectomy is beneficial up to 24 hours after stroke onset. Cytoprotection is another potential acute stroke therapy is still under study. The relative lack of awareness regarding thrombolysis and infrastructure for mechanical thrombectomy are opportunities in India to look at, added Dr Mohan.
Noting that Neuroprotection is an important area which needs to be focused upon in acute stroke management, Dr. Shobha N, consultant, neurologist and stroke physician, Manipal Hospital Malleswaram, said Nerinetide (NA1) indicated some promise in clinical trials. In ESCAPE –NA1 trial, patients who received mechanical thrombectomy within 12 hours of symptom onset showed significant improved clinical outcome.
“If patients have an acute ischemic stroke, then IV thrombolysis is advised. Here clot buster medicines: rtPA and tenecteplase are administered intravenously to lyse the clot. During a clinical trial, patients need close monitoring for any deterioration of their medical status,” said Dr Vishal Chafale , consultant, interventional neurology, Apollo Hospitals Navi Mumbai.
Stroke patient with a score of 6 or above will benefit from mechanical thrombectomy. MRI can detect stroke early. The contrast scans help to calculate the brain blood flow to act fast and minimise the brain damage. The success of thrombectomy are the 5 randomised control trials. To begin with, the treatment window was limited to only 6 hours which had limitations to get patients to the designated centers within that time and organize the treatment. Internationally, the American guidelines recommend 24 hours which is a real boon so that majority can be eligible for this treatment. Mechanical thrombectomy shows double the recovery rates compared to pure medical treatment for the stroke. Early intervention helps faster recovery and prevents disability, said Dr. Venkataramana.
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