Mumbai: Dr. Sharat Kumar GG, Senior Consultant Neurointerventional Radiologist, Apollo HospitalsBengaluru spoke with Prabhat Prakash of ETHealthWorld on advancements in stroke management with the implementation of Artificial Intelligence.Hey) and the importance of machine learning Golden hour Factors playing an important role in the treatment of stroke and the major factors contributing to the increasing incidence of stroke among young Indian adults were considered.

What are the major factors contributing to the 20 percent increase in stroke cases among young adults in India? What are the financial consequences of the increasing number of stroke cases in India, such as lost wages, reduced productivity and impact on social life?

The 20 percent rise in stroke cases among India’s young adults is a complex issue that has multiple causes. The main causes are lifestyle changes, such as increased consumption of fast food leading to obesity, diabetes and hypertension, as well as sedentary behaviour due to desk jobs and excessive screen time. Additionally, high stress levels associated with urban living and mental health concerns including sleep disorders also contribute significantly.

In addition, substance abuse including high rates of smoking and alcohol consumption as well as drug abuse increase the risk of stroke. Medical conditions such as high blood pressure, poorly managed diabetes and prevalent heart disease further increase the risk of stroke. Hereditary factors and family history of stroke or cardiovascular diseases also contribute to the incidence of stroke.

Lack of awareness can lead to a delay in diagnosis, while inadequate healthcare services, especially in rural areas, can lead to a delay in access to emergency care. Therefore, access to healthcare and awareness of symptoms also play an important role.

When we look at the financial implications of this rising trend, they are significant. Missed wages due to prolonged absence from work can lead to a significant loss of income, especially for families that depend on a sole breadwinner. In severe cases, if a stroke causes permanent disability, it can lead to a lifetime loss of income. An increase in stroke cases also impacts overall workforce productivity, impacting the economy. Frequent medical appointments, recovery periods, and reduced capacity to work can lead to increased absenteeism.

The social impact is profound, as patients must contend with high medical expenses for treatment, rehabilitation, and long-term care. Dependence on family members for care and support can increase psychosocial stress for both patients and their caregivers. Patients’ social lives may be significantly altered, leading to isolation, depression, and a reduction in social interactions and activities. To address this important public health problem, comprehensive strategies are needed. These include lifestyle modifications, improved healthcare access, and increased public awareness and education about prevention and early detection.

Can you elaborate on the importance of the ‘golden hour’ in stroke treatment and the procedures used to achieve it? mechanical thrombectomy And Stroke Thrombolysis Within a critical deadline?

The ‘golden hour’ in stroke treatment refers to the first hour after stroke symptoms begin. This is a critical time during which immediate medical intervention can significantly improve the prognosis of stroke patients, reduce brain damage, enhance recovery outcomes and reduce the risk of death.

There are two major procedures that can be performed during this ‘golden hour’ – stroke thrombolysis and mechanical thrombectomy.

Stroke thrombolysis or intravenous thrombolysis involves giving the clot-dissolving drug, tissue plasminogen activator (tPA), intravenously. The magic of tPA is in its ability to break up the blood clot blocking the artery, thereby restoring blood flow to the brain. However, the effectiveness of tPA is highly dependent on timing. It is most effective when administered within 4.5 hours from the onset of symptoms, and the best results are usually seen when given within the first ‘golden’ hour. It is important to note that not all stroke patients are eligible for tPA. There are specific criteria such as the type of stroke (it is only for ischemic strokes), the time window, and checking for contraindications such as recent surgery or bleeding disorders.

The second procedure is mechanical thrombectomy, which is a minimally invasive surgery. In this, a special instrument is used to physically remove the blood clot from the blocked artery. This procedure can ideally be performed within six hours of symptom onset, but in some cases, it can be extended up to 24 hours depending on the patient’s condition and imaging results.

In short, the ‘golden hour’ is a race against time, and these procedures are rungs on the ladder of recovery. Timely use of these treatments can save lives and reduce long-term disability associated with stroke.

What changes took place in it? Stroke Care Is technology What happened recently? Can you talk about how emergency stroke care and AI-based diagnosis can improve patient outcomes?

The role of technology in revolutionizing stroke care is truly remarkable. At the heart of these advancements is artificial intelligence (AI). AI and machine learning algorithms have made it possible to analyze CT and MRI images much faster than human radiologists. These advanced systems can identify stroke symptoms, differentiate between types of stroke, and detect smaller or less obvious abnormalities that may be overlooked by the human eye. In addition, AI tools such as Viz.ai and Aidoc are redefining stroke care by quickly interpreting imaging results and notifying specialists of potential stroke cases. This quick assessment streamlines the decision-making process, enabling faster intervention.

In addition to AI, telemedicine or telestroke services have also made a significant impact. Through remote consultations, telestroke networks connect local emergency departments with neurologists and stroke specialists via video conferencing. This means that even in rural or underserved areas, stroke patients can immediately receive expert assessment and treatment recommendations. Pre-hospital telemedicine has also gained momentum, with mobile units equipped with telemedicine capabilities enabling paramedics to connect with stroke specialists while en route to the hospital.

Another promising area of advancement is robotic and minimally invasive interventions. Improved design and functionality of thrombectomy devices have increased the success rate of mechanical clot removal procedures. Likewise, robot-assisted procedures offer better precision and control during interventions, potentially leading to better outcomes in difficult cases. Advanced stroke path systemsThese systems, including automated notification systems, are critical in stroke care. These systems can automatically alert stroke teams and prepare hospital resources as soon as a potential stroke patient is identified by EMS.

AI-powered predictive analytics has also made a positive impact. AI can analyze patient data and predict outcomes based on multiple variables, thereby aiding clinical decision-making and personalized treatment plans. AI can optimize triage processes by prioritizing patients based on the severity of their condition and their likelihood to benefit from specific treatments. Automated systems help streamline workflows, reducing critical ‘door-to-needle’ and ‘door-to-groin’ times, which are key metrics in stroke care effectiveness.

What are the essential elements of a multidisciplinary team and why is it so important to restore a stroke patient’s abilities to their pre-stroke levels? What is a full stack stroke care program, and how can it reduce the rising incidence of stroke in India?

A multidisciplinary team (MDT) is crucial in stroke care because it brings together a variety of specialists to meet the complex needs of stroke patients. The primary goal is to restore the patient’s abilities as close as possible to their pre-stroke status, ultimately improving their quality of life and allowing them to re-integrate into society.

Key members of the MDT include neurologists, who oversee patients’ medical treatment; nurses or stroke coordinators, who ensure compliance with treatment protocols; physiotherapists, who focus on restoring mobility and strength; occupational therapists, who help patients regain daily living skills; speech-language pathologists, who address communication difficulties and swallowing disorders; dietitians or nutritionists, who provide dietary plans to manage risk factors; psychologists or psychiatrists, who manage emotional changes; social workers, who assist with discharge planning; and rehabilitation specialists, who oversee comprehensive rehabilitation planning.

Restoring abilities of stroke patients is important for several reasons. It improves quality of life, provides functional independence, reduces direct and indirect costs associated with long-term disabilities, and enhances the psychological well-being of patients and their families.

A complete stroke care program includes elements such as prevention and awareness, acute stroke management, acute inpatient care, rehabilitation services, follow-up and long-term care, research and innovation, and policy and infrastructure support. Implementing such a comprehensive program in India can significantly reduce stroke incidence, as it makes it easier to ensure early identification and prevention, improve access to emergency care, provide robust rehabilitation services, raise awareness, and ensure an integrated care model.