The Minister of Health, Marcelo Queiroga, announced that by the end of the year the SUS will effectively incorporate mechanical thrombectomy, a technique that increases survival and reduces the chances of sequelae in patients diagnosed with severe stroke.
The announcement took place on Wednesday (10), during the Global Stroke Alliance, an event in São Paulo that brings together national and international politicians and experts to discuss stroke. The adoption of the procedure had already been communicated in an ordinance published in February 2021, but it has not yet been implemented in hospitals.
“There is always a gap between knowing that it has to be implemented and actually implementing it, mainly because of the necessary resources. In addition, it was necessary to complete the ordinance that regulates the use, because it is not just any hospital, it is not just any treatment. the appropriate hospital, with trained doctors”, says neurologist Sheila Cristina Ouriques Martins, president of Rede Brasil AVC.
She explains that mechanical thrombectomy is performed when the patient suffers a severe ischemic stroke, that is, when a cerebral blood vessel is clogged, compromising circulation in an area of the brain. In these cases, every minute that passes, two million neurons die and, if the vessel is not cleared, the lost region increases.
Currently, the SUS offers endovenous thrombolysis, which consists of the application of a drug. This treatment can be performed up to four and a half hours after the onset of stroke symptoms, but according to Martins, it does not work well when the clogging affects larger vessels. “Thrombolytics only open 10% to 30%, so patients are left with a lot of sequelae”, he says.
Mechanical thrombectomy, on the other hand, consists of a catheterization to remove the clot that is clogging the circulation. Doctors pass the catheter through the leg, go to the compromised vessel, and aspirate or pull out the clot using a stent. “This procedure clears the circulation in 80% to 90% of cases, a huge difference compared to thrombolysis. This increases the chance of the patient to be independent, not needing other people for daily activities by three times”, compares the neurologist .
The positive results of the technique and the possibility of implementing it in the SUS were presented by Martins and a group of researchers in a scientific article published in June 2020 in the scientific journal The New England Journal of Medicine. The study, funded by the Ministry of Health, served as the basis for the decision to incorporate the procedure.
“Now what they have to do is define how much they will pay for the devices that provide the treatment for the SUS hospitals that are already ready. We agreed to discuss in the ministry the details regarding the pre-evaluated hospitals and the reimbursement of the cost of the equipment “, says Martins.
Currently, four public hospitals offer the technique, but without dedicated resources from the federal government. Fortaleza General Hospital and Vitória State Hospital provide treatment with state funds; the São José Municipal Hospital, in Joinville (SC), receives resources from the city hall, and the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto (SP) uses its maintenance budget.
“The others have no resources and are waiting for incorporation with the cost passed on”, comments the neurologist, mentioning 15 hospitals that have the capacity to offer mechanical thrombectomy and that were suggested to the ministry for accreditation.
With the incorporation of the units, Samu teams will have more options to refer patients with severe stroke, respecting the approved interval of up to 24 hours from the onset of symptoms for performing mechanical thrombectomy.
“The path starts with educating the population to recognize the signs of stroke and to know that they should call Samu. When Samu recognizes this patient as urgent, it will identify if there is a need for thrombectomy or if it can be referred to a stroke center for thrombolysis” , explains the neurologist.
Martins says that the dynamics has already been tested in Rio Grande do Sul, with 22 ambulances, and more recently in Ribeirão Preto. With this system, he says, the hospital and staff, including the interventional neuroradiologist conducting the procedure, can stay prepared and save precious minutes.