Dr Vipul Gupta, Director- Neuro-intervention, Artemis Hospital

Dr Vipul Gupta is a visionary doctor who is regarded as one of pioneers in treatment of stroke and endovascular management of brain vascular disorders. (Neurointerventional Surgery). He has among the highest experience in our country in management of brain hemorrhage due to cerebral aneurysms or vascular malformations, as well as in diagnosis and intervention in acute ischaemic stroke.

 

Despite the precautionary measures and safety norms followed by the public and the Government, COVID has invaded the globe all of a sudden. Emerging as a pandemic, to restrict the transmission rates subsequent lockdowns were posed, but also raised concerns for many. 

Due to the fear of infection at hospital, the patient turn out rate had gone down subsequently (even those patients who were to visit for their routine follow ups). Many patients ignored early symptoms and approached the hospital only when critically ill/unconscious. Heart attack and stroke are such complications which needs immediate intervention, devoid of which can lead to permanent disability or even death.

Many stroke patients have been refraining themselves from hospital visit early. Delay in every single minute after the onset of stroke is life threatening and can lead to permanent disability if not intervened within the first 24 hours. 

However, this recent fear has created new challenges for the doctors in terms of providing appropriate and timely treatment. The neurosciences team – Artemis Agrim Institute of Neurosciences, was swift to respond to it and had developed its unique innovative protocols ensuring the safety of all. 

Time is the major factor while treating stroke. 

While treatment for acute stroke requires timely intervention to prevent morbidity and mortality risk, the COVID era has led to a lot of changes in the healthcare system, as such patients are surrounded by the fear of infection spread are delaying treatment.

Starting from the admission to emergency room, complete safety and isolation protocols have been developed till the patient reaches the OR/ Cath Lab. 

The Grey Corridor – For thorough and timely investigation of the patients, the emergency team uses PPE kits, masks and other precautions while operating, saving themselves as well as the patients. A quick assessment is done in the isolation room for any risk of COVID infection and patients are immediately shifted for CT and MRI making use of a grey corridor – ensuring isolation throughout the intra-hospital transportation. 

Zoning in Cath Lab – The Zone wise separation in the Cath Lab ensures minimum personnel vicinity, avoiding the possibility of exposure.  In the Cath lab a red zone is established around the operating table and minimum personnel remain in the zone to minimize the possibility of exposure. Even the anesthetic team are placed outside this zone until required. Such kind of zoning helps so that without losing the speed of the procedure still safety can be maintained.

Cardiac Tray intubation – If the patient requires intubation, the anesthesia team has come up with another innovation. A cardiac tray which is a frame over which sterile plastic are fit, so that if the patient needs intubation to place the patient on ventilator, this is done within this closed space so that any virus coming out of the mouth are contained. The anesthetics are also using video laryngoscopy, maintaining the social distancing while helpful with the procedure.

Minimally invasive intervention for the treatment of stroke

Acute stroke due to occlusion, of a blood vessel to the brain is an emergency and can lead to devastating outcomes with permanent weakness or other deficits to the patients. 

Thrombectomy – Thankfully with the modern treatment of thrombolysis and mechanical thrombectomy, a procedure in which the blockage is removed, can revive the brain and many patients can become normal and lead a proper life. Being, minimally invasive, Stroke thrombectomy is an established first line of emergency treatment which is highly effective and safe. The treatment restores blood flow to the brain by opening blocked arteries with catheter-based devices introduced through groin or wrist arteries and saves brain tissue from permanent damage.

However, these procedures have to be done very quickly after the stroke to achieve a proper outcome. During these tough times, our team has treated many such cases of acute stroke very safely while following with the time limits Internationally described guidelines.

Stroke being a life-threatening condition, if patients come in soon, within hours to an appropriate thrombectomy capable hospital, then the thrombectomy procedure to restore the blood flow to brain can reverse the paralytic attack in many of these patients. However, because of fear of COVID 19 and due to hospitals being overburdened in this era, many patients are not receiving the appropriate treatment. This has led to permanent disability in many of these patients. 

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