Mission Thrombectomy 2020 (MT2020)—India’s Biggest Healthcare Challenge Yet

Abstract

Large vessel occlusion has a disproportionately large contribution to overall mortality and morbidity from stroke. The Society of Vascular and Interventional Neurology in the year 2016 announced the launch of Mission Thrombectomy 2020 (MT2020), with the aim of increasing access to stroke thrombectomy globally. Despite 4 years since the start of MT2020, India is falling short in acute stroke therapy including thrombolysis and mechanical thrombectomy (MT). Access to timely MT leads to substantial mitigation of adverse stroke outcomes. This in turn leads to an enormous health benefit in that population. MT as a treatment is unevenly and unfairly distributed and increasing access to it is in need of strategies targeting political, economic, and environmental factors. Such strategies are slowly being adopted. In this article, we attempt to look at the major hurdles we face in improving acute stroke care in our country and we also explore options to address them.

Proposed Model to Improve Acute Stroke Care in Central India

“…In a study published in Western population, the net monetary benefit in patients treated with mechanical thrombectomy stands between $74,000 and $132,624. 4…”

“…The population of India is estimated to be around 137.5 crore and considering that the rough incidence of stroke is 150/100,000, the estimated incidence of acute stroke is around two crores, nearly half of these patients will be eligible for and will benefit from acute stroke interventions. 4…”

Thrombectomy for Stroke in Brazil—Late Evidence or Promising Future?

“…This challenge is a worldwide concern, which led the Society of Vascular and Interventional Neurology to launch the Mission Thrombectomy, aiming for a global expanding of thrombectomy to reduce the morbidity and mortality related to stroke. Despite this effort, many organizational restrictions persist, keeping important inequalities and disparities in the access to thrombectomy (6).…”

10th Anniversary of the Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia-Pacific

“…Some countries have highly advanced care and reimbursement policies which allow most of the patients access to treatment. However, similar to the other parts of the world, higher mortality is evident in patients with acute stroke occurring in countries in lower socioeconomic strata with reasons such as lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, lack of availability of thrombolysis and endovascular treatment, insufficient stroke unit beds, and lack of affordability of new interventional therapies [ 24 , 25 ]. As for transportation, the majority of acute stroke patients in Asia still depend on non-EMS, e.g., private cars and public transportation, while on the other hand, mobile stroke units have been implemented in certain areas of India, China, and Thailand [ 26 ].…”

“…Most of the countries use the standard 0.9 mg/kg dose except for Japan where the recommended dose is 0.6 mg/kg. Endovascular treatment is also currently available in many countries, but the accessibility is still limited due to cost, lack of trained internventionalists, and inadequate resources in public hospitals [ 8 , 25 ]. Stroke network systems and telemedicine is more widely used for acute stroke care in Asia such as in China, India, Japan, and Thailand.…”