Regarding Dr. Pacheco and Dr. Rocha's statement[1] that future conditions of care for stroke patients in Brazil may worsen, given the
need for implementation and updating of stroke centers, we acknowledge that this could
be true if our Brazilian Stroke Society was not taking the necessary measures, but
there has been great effort in improving this scenario. There has been an effort by
specialized neurologists to improve care and teach the population to recognize the
signs of stroke and to seek care as soon as possible[2], as well as efforts from the stroke organizations to improve the conditions of stroke
care[3].
The establishment of several multiprofessional and properly-trained stroke teams all
over the country is a challenge that we hope will be achieved. Undoubtedly, the presence
of the neuroradiologist and the neurointerventionist are fundamental in this team
for neurointerventional treatment, which has shown excellent results when appropriately
indicated and conducted[4],[5],[6]. In our setting, there is a very large ongoing study entitled RESILIENT (EndoVascular
Treatment with Stent-retriever and/or Thromboaspiration vs. Best Medical Therapy in
Acute Ischemic Stroke - ClinicalTrials.gov
identifier [NCT number:
NCT02216643]), led by Dr. Sheila Martins, that will evaluate the feasibility of mechanical thrombectomy
in properly-selected patients in the Brazilian public health setting.
Non-contrast head computed tomography is very useful for patients who arrive at the
hospital within 4.5 hours of the stroke because it allows the use of chemical thrombolysis[7], which has good results, and should be the method to start treatment. Complex cases
that could benefit from neurointerventional therapy can benefit from the “drip-and-ship”
treatment model[8], which consists of transporting patients who do not respond to chemical thrombolysis,
or who are identified as being able to benefit from endovascular treatment, to another
facility that can provide it; it is a safe and feasible alternative to ensure that
all patients have access to appropriate treatment. Another alternative would be to
improve the prehospital triage, referring all stroke patients to specific stroke centers
that have the structure to provide adequate treatment, including neurointerventional
treatment if needed (the “mothership” model)[9]. These actions could aid in improving the allocation of resources for the treatment
of stroke.
Our study[10] aimed at analyzing the current care situation in Brazil through the evaluation of
neurologists, pointing out the difficulties and limitations, contributing to the detection
of failures and trying to find solutions, which consist of improving the knowledge
of the disease in the population, better medical training and greater and better funding
and government support.
