Since 2015, Mechanical Thrombectomy has been regarded as the standard of care for large vessel occlusion (LVO) stroke, following randomized trials that demonstrated its robust superiority when compared to medical management alone. Subsequently, noteworthy advancements have resulted in increasing access to MT. However, as one might expect, substantial disparities persist between high-income and low- to middle-income countries (LTMICs) in their capacity to administer this treatment.
Part of the mission of the World Stroke Organization (WSO) is to enhance resources for stroke treatments globally. It might be assumed that expanding access to MT would be "overly challenging," given the advanced infrastructure that is required to provide this care. Yet, I would argue that delivering treatment with MT globally faces similar challenges to providing any other form of stroke treatment. Moreover, many of the strategies currently being implemented to reduce stroke treatment gaps could also be leveraged to enhance global access to thrombectomy.
We have created the Mechanical Thrombectomy Training Pathways program to complement the ongoing endeavors of the WSO in aiding hospitals from LTMICs to provide stroke treatments according to the highest standards, via the WSO/Global Stroke Alliance Stroke Center Certification program. Our MT training initiative is intended for hospitals that have either sought certification or have already gained certification as an ‘advanced’ stroke center. The program is customized to address the specific needs of each individual hospital, and the MT treatment challenges unique to their respective regions. Since 2022, we have conducted personal visits to 13 hospitals across 4 countries. Additionally, hybrid conferences have engaged thousands of participants – for instance, our virtual registration in Mexico alone included approximately 2,000 caregivers, with an average of 700-900 attendees joining daily conferences online. This program provides an experienced neurointerventionalist available for a 7-day period to support all MT cases at the participating hospitals during that week. Additionally, a comprehensive educational curriculum is integrated throughout the week for both interventional and non-interventional staff. Industry partners also contribute by providing flow models and devices for hands-on sessions with physicians and trainees.
Recently, we have also implemented MT training courses for NIR physicians utilizing bio-imitative anatomical models observed under fluoroscopy, acrylic flow modes, and virtual reality simulation. This specialized training is exclusively designed for physicians with formal education in neurointervention. Through an open survey we can identify physicians with the necessary resources to perform MT procedures based on stroke admissions, referral patterns and existing hospital infrastructure. Earlier this month, seventeen physicians convened in Neiva, Colombia to participate in a comprehensive 20-hour MT course. This course was followed by a press conference and included a combination of didactic lectures, engaging case discussions, and hands-on practice sessions. In a subsequent survey conducted after the course, all physicians found the course to be ‘practice-changing’ (71.4% strongly agree, 21.4% agree, 7.1% agree with some local limitations), and all physicians felt more confident with their MT skills at the end of the course (85.7% strongly agree, 14.3% agree). We believe this positive feedback highlights the effectiveness of our training approach and its impact on enhancing the capabilities and confidence of the participating neurointerventionalists. We are equally excited to extend our initiatives into South Asia, as we prepare to host a similar thrombectomy course in New Delhi, India. This event is integrated within the upcoming GSA Ministerial Meeting, scheduled for September 2023, and will include 28 neurointerventional physicians, representing India, Bangladesh, and Sri Lanka.
Undoubtedly, MT stands out as the most transformative treatment for patients with LVO stroke. As we face multiple challenges to increase access to MT, we recognize that this endeavor surpasses the capabilities of a single individual or society. The dedication and expertise of multiple individuals combined with the collective efforts of international organizations, remain crucial to fostering collaborations that will enhance provider education and MT treatments to the level they are urgently needed.
I remain grateful to the WSO, under the esteemed leadership of Dr. Sheila Martins, for their recognition of the paramount significance that MT education holds within the realm of stroke care. The collaborative efforts of organizations like WSO are instrumental in shaping the future landscape of medical training and patient care, and I am honored to be part of this shared journey towards excellence.
Dr. Violiza Inoa
Interventional Neurologist, Semmes Murphey Clinic, Memphis, TN, USA
Chair, WSO Mechanical Thrombectomy Training Pathways Program
Achieving our vision of a life free from stroke is a task that WSO cannot achieve alone. We are committed to building our partnerships at the global, regional and national level to scale up and deliver improvements in prevention, treatment and support to reduce the burden of stroke.