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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(03): 217-219
DOI: 10.1055/s-0041-1740573
Short Communication

Stroke Interventions by Non-Neurointerventionists: Learning from Indian Epic Mahabharata

Vikas Bhatia 
1   Department of Radio-Diagnosis, PGIMER Chandigarh, Chandigarh, India
,
Ajay Kumar
1   Department of Radio-Diagnosis, PGIMER Chandigarh, Chandigarh, India
,
Sucharita Ray
2   Department of Neurology, PGIMER Chandigarh, Chandigarh, India
› Institutsangaben Funding None.
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Mechanical thrombectomy (MT) has become the gold-standard treatment for large vessel occlusion. Recently, there has been a growing interest in the cardiology community to perform MT in acute ischemic stroke (AIS) patients.

The good intentions to treat such patients when a neurointerventionist is not available reminds us of the story of the great warrior Abhimanyu from the Indian epic Mahabharata.[1] The story of Abhimanyu ([Fig. 1]), is a perfect example of bravery yet shows the hazards of possessing incomplete knowledge. Abhimanyu had learned breaking into battle formation—the “chakravyuh” (chakra-round, vyuh-formation), while he was still in his mother's womb. One day when still in the womb, his mother fell asleep and he could only partly learn the process. Later, on one fateful day during the Mahabharata war, when Arjuna was away there was no choice but to use young Abhimanyu to penetrate the “chakravyuh.” Although he fought with bravery, ultimately his partial knowledge got the better of him and, unable to extricate himself out of the “chakravyuh,” he finally perished on the battlefield.

Zoom Image
Fig. 1 Injured Abhimanyu fighting on the battlefield.

For the sake of our discussion, let us view now Abhimanyu as a non-neurointerventionist who has to take up the chakravyuh (AIS) when the experienced warrior Arjuna (neurointerventionists) is not present.

Life is a chakravyuha—a complicated situation like acute stroke can present any time:

Mahabharata reminds us that a tough situation can appear at any time in our life. The incidence of stroke is indeed very high with an ever-increasing demand for an interventionist to perform acute stroke interventions. It requires rapid training of suitable manpower which includes interventionists, health care workers, trained stroke nurses, better teleradiology and communication systems, a dedicated stroke protocol, and community-based approaches.[2]

The thought of acquiring more only brings destruction (any new intervention should be based on need not desire):

The desire of acquiring more and dissatisfaction was the core of Mahabharata. Whenever a Level I guideline is given, there are tremendous efforts by the researchers working in that field.[3] The moral is that while it is true that more hands are needed to fill the gaping shortage of neurointerventionists, however, the desire to enter a field evolved and firmly entrenched by other specialties should purely be based on goodwill to provide benefit to the patient community and not competitive.

We state that this article is not submitted to any other journal and is our original work

IEC – approved.




Publikationsverlauf

Artikel online veröffentlicht:
11. Januar 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Aggarwal P. 11 Lessons from Mahabharat Abhimanyu, Beauty of soul. 2020 . Accessed July 20, 2020 at: https://beautyofsoul.com/blog/mahabharat-abhimanyu-lessons-story/
    PubMedSuche in Google Scholar
  • 2 Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc 2015; 8: 433-442
    CrossrefPubMedSuche in Google Scholar
  • 3 Goyal M, Menon BK, van Zwam WH. et al; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387 (10029): 1723-1731
    Suche in Google Scholar
  • 4 Htyte N, Parto P, Ragbir S, Jaffe L, White CJ. Predictors of outcomes following catheter-based therapy for acute stroke. Catheter Cardiovasc Interv 2015; 85 (06) 1043-1050
    CrossrefPubMedSuche in Google Scholar
  • 5 Widimsky P, Asil T, Abelson M. et al. Direct catheter-based thrombectomy for acute ischemic stroke: outcomes of consecutive patients treated in interventional cardiology centers in close cooperation with neurologists. J Am Coll Cardiol 2015; 66 (04) 487-488
    CrossrefPubMedSuche in Google Scholar
  • 6 Guidera S, Boland D, McGarvey J. et al. TCT-210 3 year experience with cath lab based acute stroke rescue program in a community hospital. J Am Coll Cardiol 2018; 72 (Suppl. 13) B88
    CrossrefPubMedSuche in Google Scholar
  • 7 Hornung M, Bertog SC, Grunwald I. et al. Acute stroke interventions performed by cardiologists: initial experience in a single center. JACC Cardiovasc Interv 2019; 12 (17) 1703-1710
    CrossrefPubMedSuche in Google Scholar