“I have to thank life for this second chance it has given me”, celebrates Antonia Pérez, about to turn 53. On January 8, this resident of Les Roquetes (Sant Pere de Ribes, Garraf) had a serious stroke and now barely has any sequelae. Some memory failure, some word that doesn’t quite appear. Nothing more, except for an amalgam of medicines to keep various health parameters at bay. “I lead a normal life, like before, except that I smoked a little and I’ve stopped smoking,” he explains.
Thanks to her husband, who identified the symptoms, Antonia was urgently taken to Bellvitge hospital. If it were up to her, she says, she would have gone back to bed to sleep. “And who knows what could have happened to me”. Because, when it comes to a stroke, time is brain, say the doctors. Every minute that passes until treatment is lost, 1.9 million neurons are lost, and every 15 minutes without receiving the appropriate attention, a month of disability-free life is deducted. “It is a devastating disease, the first cause of mortality in women and the first cause of disability in the population”, says Carlos Molina, head of the Vall d’Hebron stroke unit.
Since the challenge consists of subtracting time from time, Antonia Pérez’s journey began fatally. The operating room in Bellvitge was busy and the ambulance had to go to Vall d’Hebron. There, the patient underwent world-leading stroke technology and treatment. The so-called One Step Ictus, a revolutionary procedure that was in the trial phase, was presented yesterday after a year of testing. What would be normal, in view of the results, is for it to spread from Vall d’Hebron to all the hospital centers specializing in the treatment of brain ischemia and hemorrhage.
One Step Ictus represents a transformation of patient care based on the concentration of the entire procedure in a single room: directly from the ambulance or emergency department to the One Step Ictus room, where the diagnosis is made , the clinical assessment, the surgical intervention and the stabilization of the patient. “This project is not only a new way of dealing with the stroke code, it also means saving time, gaining time, and in strokes acting quickly is key”, explained the Minister of Health, Manel Balcells.
“The pioneering technological solution of the One Step Ictus room combines a two-plane angiograph to perform mechanical thrombectomy (removal of the thrombus that blocks blood circulation) with equipment to perform the CT scan before, during and after the thrombectomy and evaluate the cerebral blood flow of the patient”, said Manel Escobar, clinical director of the diagnostic imaging service.
This unification of examination and treatment – ??which avoids running through the corridors between various departments and, above all, saves time – almost doubles the probability of recovery for the most serious strokes. “We calculate that 48% can reach a practically total clinical recovery after three months after undergoing a direct thrombectomy, compared to 27% of patients who follow the traditional circuit”, said Dr. Molina.
Vall d’Hebron’s goal is to normalize a lapse of 17 minutes from the time the patient arrives at the hospital until he is intubated in the stroke ward. Currently, the average is 47 minutes, but it is decreasing, according to Molina: “On Wednesday, 27 minutes passed between the time an ischemic stroke patient arrived and we already had him intubated. It used to take us between an hour and a half or two hours.” This means more than a hundred million neurons saved.
“It’s about removing the thrombus or covering the closed aneurysm. It occurred to us that by doing everything, diagnosing with a scanner and doing the intervention, we would gain a lot of time at the same point, and time is the brain”, recalled Manel Escobar, director of the imaging diagnostic service: ” It is a unique room in Catalonia and in Europe. We don’t have to move the patient from the table, what moves is the scanner, which works with magnetic rails so that the patient is always in conditions of maximum safety”.
With an investment of 18 million euros, 50% financed with European Feder funds, the project incorporates the most innovative technology to speed up diagnosis and intervention, developed by Medtronic and Siemens Healthineers. In addition, it is completed with the SmartStroke digital platform, which integrates the patient’s clinical history with the rest of the data generated in the hospital and facilitates remote monitoring, which allows risk factors to be monitored from home vascular and rehabilitation.
Antonia Pérez did not learn that she was treated using the revolutionary Vall d’Hebron model. “The worst moment – he remembers – was when they told me I needed to operate, that they entered through the groin and reached your brain through an artery. I thought: ‘My mother, what progress'”. It happened on a Sunday, the same week that he had closed the market stall in Les Roquetes where he worked and had become unemployed. Antonia got up at eight in the morning, she noticed that her body was not supporting her, she began to sway until she lost her balance and fell to the ground. “I didn’t know it could be a stroke, I thought it was dizziness or a drop in tension. Anyway, I’ve been very lucky, it was just a coincidence that it happened at that time. If it happens to be a Monday when my husband is working and my daughter is at high school…”.
It is estimated that around 560 patients a year will be able to benefit from the new treatment system. Vall d’Hebron treated 1,945 cases last year, of which 1,433 were ischemic strokes, 180 transient ischemic attacks and 64 hemorrhagic strokes.
