First Stroke Center

Due to the increasing incidence of patients suffering from stroke, a letter dated September 2008 (Annex I& II) was issued to develop a state of the art Stroke Center within the department.However as that did not lead to any tangible results, the personnel of the department made every effort to receive international training and experience in mechanical thrombectomy.On 23rd December 2014 a team of professionals led by the Head of the Neuroradiology Department, Dr. Umair Rashid and assisted by local and international experts successfully performed the first mechanical thrombectomy on two patients in Pakistan. (Annex III) Building on this success, it is proposed that a Stroke Center located in the Neuroradiology Department, LGH be set up to cater to patients suffering from strokes. The Stroke Center will give patients the opportunity to avoid paralysis and disability that are caused as a direct result of strokes.

History

On 23rd December 2014, the Neuroradiology Department at Lahore General Hospital successfully treated two patients suffering from Ischemic stroke through mechanical thrombectomy. It was a major breakthrough as this was the first time such a procedure was performed in Pakistan. An Ischemic stroke occurs because of a loss of blood supply to parts of the brain leading to permanent disability and in many cases, death. Even though many countries are successfully performing mechanical thrombectomy, in Pakistan patients are only offered conventional treatment through medication leading to disability or death that in majority cases could have been prevented. International experience demonstrates that through mechanical thrombectomy, effects of an Ischemic stroke may be reversed and paralysis can be avoided.

The Neuroradiology Department at Lahore General Hospital has the required trained personnel and medical equipment to perform mechanical thrombectomyhowever the Department urgently needs the following to develop a Stroke Center:

  • Disposable medical items
  • Availability of anesthesia services throughout the week
  • Availability of post care services
  • Availability of medical staff for round the clock care

Stroke is the most common cause of disability and a leading cause of mortality worldwide. Even though the incidence of stroke is falling in developed countries, it is projected to increase enormously in Pakistan due to increasing risk factors associated with stroke.The proposed Stroke Center will be the first such center set up in Pakistan and would vastly improve the treatment, well-being and survival rate of stroke patients in the country. 

Background

Lahore General Hospital is renowned for its Neurological services. The first and only dedicated Neuroradiology Department was developed as an integral part of the Neurosurgery in 1970. By 1994, the Nueroradiology Department at LGH was declared as a separate and autonomous specialty. In 2000, through the efforts of the Departments own personnel, the Neuroradiology Department evolved from a diagnostic facility to a treatment facility offering neuroendovascular treatment and spinal intervention. By 2010, the treatment facilities were expanded to include neuroendovascular treatment for aneurysm (coiling), AVM and Dural AVF (embolization) that in the last four years alone has saved 600 lives.

Existing Facilities

  • 5 trained doctors
  • 6para-medical staff
  • Latest and only Bi plane Neuro-Angio Machine in Pakistan 
  • MRI, Carotid Doppler and 2 CT Scans  

Achievements

Today the Neuroradiology Department functions as a diagnostic and treatment center for blood vessel diseases in the brain and spine including head and neck. Since 1990, the Department has diagnosed over three hundred thousand patients. After evolving into a treatment center in 2000, it has treated over fifteen hundred patients through different treatment facilities that have been added over the years.

Requirements for the Stroke Center

  • Disposable medical items

To perform mechanical thrombectomy at the proposed Stroke Center, disposable medical equipment including catheters, micro-wire, stents and other small medical appliances will be required.

  • Availability of Anesthesia services throughout the week

Currently the Neuroradiology department at LGH has access to anesthesia services only once a week causing significant delays in the treatment of the patients. Due to the nature of strokes, timely intervention ranging from 8-24 hours will be critical for successful treatment thus making it absolutely essential that anesthesia services be made available throughout the week.

  •  Availability of Post Care Services

The current treatments being offered by the Neuroradiology Department do not require aggressive post-care services however for patients with strokes, it will be essential to develop intensive post-care services. It is being proposed that at least 5 facilities for post-care services be set up next to the Angio Suite

  •  New Staff comprising 3 Doctors, 5 nurses and 2 Angio technicians

The Stroke Center will require 3 doctors (related to Neuroradiology), 5 nurses with ICU and Angio experience and 3 Angio technicians to ensure that round the clock services are offered to the patients.

Advantages of the proposed Stroke Center

  • Patient care will vastly improve by significantly reducing the chances of continued paralysis, disability and death
  • It will serve as the first and only Stroke Center in Pakistan 
  • It will offer an internationally recognized form of treatment previously unavailable to patients in Pakistan 
  • Through Post Graduate training facilities, it will train other medical professionals in neurointervention 
  • It may be affiliated with international societies and centers in the field of Neuroradiology  
  • No significant financial investmentin machines and/or training is required.