High-tech application in stroke treatment at Thanh Hoa Provincial General Hospital

By connecting the inter-hospital emergency system and the internal red alert system, many stroke patients have been successfully rescued after only 30 - 45 minutes of entering the hospital thanks to the rapid treatment process and application of modern techniques at Thanh Hoa Provincial General Hospital.

High-tech application in stroke treatment at Thanh Hoa Provincial General Hospital 1.5 Tesla MRI machine at Thanh Hoa General Hospital helps screen and evaluate stroke effectively.

At the end of April 2023, the Stroke Unit, Department of Neurology - Stroke, Thanh Hoa Provincial General Hospital suddenly activated an urgent red alert order to prepare to handle a stroke case with a high risk of death transferred from a lower level. Doctors from related specialties quickly arrived, urgently provided emergency care, promptly saved the life, and minimized sequelae for a patient after just over 30 minutes of hospitalization.

About 3 hours earlier, patient LVH, 66 years old in Dinh Tang commune (Yen Dinh) suddenly had symptoms of difficulty speaking, crooked mouth, lethargy, paralysis of the right side of the body, agitation and agitation, so his family took him to a medical facility in the province for emergency treatment. Doctors prescribed intravenous thrombolytic drugs for the patient. However, because the blocked blood vessel could not be reopened, the patient's condition gradually worsened. Immediately, doctors at the lower-level medical facility held an online consultation on the Thanh Hoa Stroke Emergency Team with experts from the Department of Neurology - Stroke, Thanh Hoa General Hospital and transferred the patient to Thanh Hoa General Hospital.

The patient's prognosis required urgent emergency intervention, to take advantage of the golden time in stroke emergency because by the time of consultation, the patient had entered the 5th hour of illness. Immediately upon receiving the referral information from the lower level, the doctors of the Emergency Center and the Stroke Unit of Thanh Hoa General Hospital activated the internal red alert system, informing relevant units in advance to prepare human resources, equipment, and tools for emergency emergency as soon as the patient was transferred. Within 30 minutes of admission, the patient had received the necessary paraclinical indications. The results of the 1.5 Tesla MRI scan of the patient's cerebral vessels and the patient's cerebral vascular reconstruction showed an image of complete stenosis of the left internal carotid artery accompanied by atherosclerosis. The doctors diagnosed the patient with acute cerebral infarction due to cerebral artery thrombosis. If not treated urgently, the chance of recanalization is very low and the risk of death is possible. Immediately afterwards, the patient was transferred directly to the intervention room, where the doctors of the intervention team inserted a catheter into the femoral artery, reached the blood clot, and used a Solitaire mechanical device to remove the blood clot. After just over 2 hours of intervention, the re-evaluation results showed that the patient was awake, had good contact, spoke clearly, and was no longer paralyzed on the right side of the body. After 5 days of treatment, the patient recovered well, could walk normally, and was discharged from the hospital.

Doctor CKII Nguyen Hoanh Sam, Head of Neurology - Stroke Department, Thanh Hoa General Hospital, said: In the case of LVH patients, if the cerebral blood vessels are not re-opened in time, the risk of disability or even death is very high. By mastering the technique of removing blood clots with mechanical devices, in recent times, Thanh Hoa General Hospital has helped many stroke patients escape disability and even death. However, this is a high-level technique that requires very strict indications. In addition to modern equipment and the expertise of doctors, one of the success factors is that the patient must go to the hospital as soon as possible, after detecting a stroke within the golden period (the first 6 hours) from the onset of the disease.

According to statistics from the Vietnam Stroke Association, in recent years, the rate of stroke patients admitted to the hospital during the golden hour is still very low, only about 10 - 15%, and about 85 - 90% of patients are admitted late, so they do not benefit from modern treatment methods such as intravenous thrombolysis, mechanical thrombolysis... At Thanh Hoa General Hospital, to make the most of the "golden hour" in emergency treatment of stroke patients, when there is an urgent order to alert the hospital to provide emergency treatment for stroke patients, the doctors of the Emergency Center will immediately connect with the interdisciplinary departments of emergency, neurology, diagnostic imaging, vascular intervention... Security, elevators, and nurses give priority to opening separate passages. Patients are assessed right in the emergency room and quickly receive a CT or MRI scan according to the priority flow. CT and MRI results are consulted and read by relevant specialists right on the PACS system, and can even be consulted remotely on mobile devices, thereby deciding on appropriate treatment or intervention plans within a maximum of 30 - 45 minutes from the time the patient is admitted to the hospital.

In addition, as the province's final hospital, neurology - stroke specialists of Thanh Hoa General Hospital have established a stroke emergency network and an online consultation zalo group on neurology and stroke to provide professional guidance to lower-level facilities for emergency and difficult cases. The hospital also regularly organizes training programs and seminars on neurology - stroke with domestic and international experts as speakers to update knowledge for lower-level medical staff. The current trend in the world for the treatment of cerebral stroke is that small centers will perform intravenous thrombolysis, if not recanalized, the patient will be transferred to large centers capable of mechanical intervention to remove blood clots.

To keep up with the treatment trends in the world, Thanh Hoa General Hospital regularly holds training programs on thrombolysis for lower levels with the hope that all district hospitals with CT machines can apply thrombolysis techniques right at their facilities, thereby increasing the rate of stroke patients receiving timely emergency care and recanalization treatment over the years. With the efforts of the brain stroke emergency and treatment team in the past time, in 2022, Thanh Hoa General Hospital was awarded the Platinum certification by the World Stroke Organization (WSO). Up to now in Vietnam, Thanh Hoa General Hospital is one of the few provincial hospitals to achieve the Platinum certification.

Article and photos: Ha Phuong

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