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Improving Global Access to Lifesaving Stroke Care

Article Summary
  • Miller School neurologist Dr. Dileep Yavagal used his platform at the Society for Vascular and Interventional Neurology (SVIN) 2023 Annual Meeting to advocate for broader access to thrombectomy for stroke patients.
  • Dr. Yavagal estimates there is a 97% gap in patient access to thrombectomy at a global level.
  • During the meeting, Dr. Yavagal also presented results from a first-in-man clinical trial that delivered stem cells via catheter into the artery of areas of the brain injured during stroke.

Dileep Yavagal, M.D., used his platform as co-chair of a Society for Vascular and Interventional Neurology (SVIN) 2023 Annual Meeting roundtable to advocate for broader patient access to lifesaving thrombectomy procedures.

Dileep R. Yavagal, M.D., at work in the laboratory.
Neurologist Dileep Yavagal, M.D., wants to expand access to thrombectomy for stroke patients.

Dr. Yavagal, professor of clinical neurology and neurosurgery at the University of Miami Miller School of medicine and a past president of SVIN, founded Mission Thrombectomy. The global initiative aims to increase access to stroke care throughout the world. Thrombectomy, which removes blood clots blocking arteries in the brain during stroke, is an important factor in achieving that lofty goal.

Speaking during the “Meeting the Twin Challenges of Global Thrombectomy Access and Workforce Training” roundtable he co-chaired, Dr. Yavagal, also chief of interventional neurology at the Miller School, said, “The Mission Thrombectomy and roundtable meeting are the first-of-its-kind campaign and meeting to address the massive gap in access to the brain-saving and lifesaving therapy of thrombectomy at a global level.”

Dr. Yavagal’s remarks underscored the moment of silence that honored the late Ralph L. Sacco, M.D., M.S., former professor and chair of neurology at the Miller School, who once said, “Thrombectomy is the greatest hope for defeating stroke.”

Increasing Access to Stroke Care

Mechanical thrombectomy has become the standard of care for large vessel occlusion stroke, which accounts for as many as 30% of strokes worldwide. Surgeons remove blood clots using a wire-cage stent retriever, which is often combined with a catheter with applied suction.

The surgery is known to save lives and prevent stroke-related disability. But most patients, in the U.S. and worldwide, do not have access to the procedure, according to Dr. Yavagal.

“This was a multi-society and multi-company roundtable to drive consensus on what we estimate the gap in access to thrombectomy is globally and how to train the workforce for thrombectomy worldwide to meet the workforce gap,” he said.

The journal Circulation published a Mission Thrombectomy study earlier this year that defined the gaps in access to thrombectomy and the corresponding workforce shortage.

“There is more than a 97% gap in access to thrombectomy at a global level, and an 84% gap in access in the workforce that’s needed to cover the stroke burden,” Dr. Yavagal said. “We wanted to get consensus on this from the other stakeholders and discuss and deliberate on some solutions for a goal for 2030.”

The November 16-18 SVIN meeting in Miami Beach was the largest on record, with about 1,250 in-person and 150 virtual attendees. The meeting’s size and scope, as well as its innovation-inspired theme, offered an ideal platform to put a spotlight on the initiative, according to Dr. Yavagal.

Pioneering Stem Cell Research

Dr. Yavagal, who also directs the Miller School’s Neurological Stem Cell Platform and is a member of the Interdisciplinary Stem Cell Institute (ISCI), presented his stem cell research involving a first-in-man case that delivered stem cells via catheter into the artery of areas of the brain injured during stroke.

“We found the approach to be safe, with a signal of a possible benefit of the patient getting out of his locked-in syndrome (total paralysis of face arms and legs on a ventilator-assistance while cognitive abilities remain),” Dr. Yavagal said.

Eighteen months after the intra-arterial delivery of stem cells into the brain stem, Dr. Yavagal reported that the patient is breathing on his own, able to lift his right upper extremity to his mouth and feed himself with assistance.

“It’s a very exciting outcome,” he said, “because fewer than 3% to 4% of locked-in syndrome patients can ever achieve this spontaneously.”

The patients also saw significant reduction in stroke swelling within the first 10 days of the experimental treatment, and a much greater reduction at a year.

“These are very exciting initial results showing great promise for this therapy to be tested in larger studies and eventually become available to all stroke patients who haven’t recovered,” Dr. Yavagal said.

Challenges and Achievements in the Middle East, North Africa

Miller School of Medicine neurologist Dr. Negar Asdaghi.
Dr. Negar Asdaghi moderated the MENA-SINO platform during the SVIN annual meeting.

Negar Asdaghi, M.D., FRCPC, associate professor of clinical neurology at the Miller School, moderated the Middle East North Africa Stroke and Interventional Neuro-Organization (MENA-SINO) SVIN platform at the annual meeting.

“MENA-SINO an important neuro-interventionalist and stroke physician platform of over 18 countries. We discussed and shared groundbreaking research on a variety of timely topics,” Dr. Asdaghi said, including approaches to thrombectomy complications, management of delayed cerebral ischemia in patients with subarachnoid hemorrhage, treatment of arteriovenous malformation and collateral circulation in acute stroke.

“Dr. Asdaghi’s invitation to moderate that session is a testament to the national and international expertise we have in stroke and interventional neurology at the Miller School,” Dr. Yavagal said.

Tags: Dr. Dileep Yavagal, Dr. Negar Asdaghi, neurology, neurosurgery, stroke, thrombectomy