Treatment of severe stroke cases should reach SUS by the end of the year

Treatment of severe stroke cases should reach SUS by the end of the year

The Minister of Health, Marcelo Quiroga, announced that by the end of the year, the SUS will effectively integrate mechanical thrombectomy, a technique that increases survival and reduces the chances of sequelae in patients diagnosed with acute stroke.

The announcement was made on Wednesday (10), during the Global Stroke Alliance, an event in São Paulo that brings together local and international politicians and experts to discuss stroke. Adoption of the procedure was already reported in a decree published in February 2021, but it has not yet been implemented in hospitals.

“There is always a gap between knowing that it has to be implemented and actually doing it, mainly due to the resources needed. In addition, it was necessary to complete the order regulating use, because it is not just a hospital, says neurologist Sheila Christina Oryx Martins, president of Rede Brasil. AVC, it’s not just a treatment.The right hospital, with trained doctors.

She explained that mechanical thrombectomy is performed when a patient has had a severe stroke, that is, when a cerebral blood vessel is blocked, harming blood circulation in an area of ​​the brain. In these cases, every passing minute, two million neurons die, and if the vessel is not cleaned, the missing area increases.

Currently, SUS offers intravenous thrombolysis, which consists in applying a drug. This treatment can be done up to four and a half hours after stroke symptoms appear, but according to Martins, it doesn’t work well when the blockage affects the larger vessels. “Thrombolytic drugs only open 10% to 30%, so patients are left with many consequences,” he says.

On the other hand, mechanical thrombectomy consists of a catheter to remove the clot that is blocking the blood circulation. Doctors pass the catheter through the leg, go into the compromised vessel, and blister the clot or withdraw it with a stent. The neurologist compares “this procedure clears the blood circulation in 80% to 90% of cases, which is a big difference compared to thrombolysis. This increases the patient’s chance of independence, not needing other people to do daily activities by three times.”

Martins and a group of researchers presented the positive results of this technique and its potential for implementation at SUS in a scientific article published in June 2020 in the scientific journal The New England Journal of Medicine. The study, which was funded by the Ministry of Health, served as the basis for the decision to incorporate the procedure.

“Now what they have to do is decide how much they will pay for the devices that provide treatment to SUS hospitals that are already ready. We agreed to discuss the details in the ministry on the previously evaluated hospitals and reimburse the costs of the previously evaluated hospitals. The cost of the equipment,” says Martins.

Currently, four public hospitals offer this technology, but without dedicated resources from the federal government. Fortaleza General Hospital and Vitoria State Hospital provide state-funded treatment; São José Municipal Hospital of Joinville (SC) receives resources from the city council, and Hospital das Clinicas of the Ribeirão Preto School of Medicine (SP) uses its own maintenance budget.

“Others have no resources and are waiting to establish with the transferred cost,” comments the neurologist, referring to 15 hospitals that have the capacity to offer mechanical thrombectomy and that have been proposed to the ministry for accreditation.

By consolidating the units, Samu teams will have more options for referring patients with acute stroke, considering the approved interval of up to 24 hours from onset of symptoms for mechanical thrombectomy.

“The path begins with educating the population to recognize the signs of a stroke and to know that they should contact Samo. When Samo realizes that this patient is urgent, he will determine if a thrombectomy is needed or if he can be referred to a stroke center coagulation center,” explains Physician nerves.

Martins says the dynamics have already been tested in Rio Grande do Sul, with 22 ambulances, and most recently in Ribeirão Preto. With this system, he says, the hospital and staff, including the interventional neuroradiologist performing the procedure, can stay prepared and save precious minutes.

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