Egyptian Experts against Stroke group (EXPANSE) group
Background & Objective
Stroke is the first cause of disability and second cause of death in egypt. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000. That means annually we have more than 500,000 new strokes in the first populous country in MENA-region with 102 m population. our published data shows that LVOs stroke represent a number between 23-39 % of all Ischemic strokes in our population. That means , every year , there are 115,000 to 195,000 new LVOs stroke. Realizing the magnitude of the gap between the between who must be eligible mechanical thrombectomy and who realistically received the treatment could be figured out when we know that in 2017 the total number of MT procedures was about 220 cases and in 2016 was about 109 cases ( data from industry partners ). This miniature service ( total number of MT for eligible LVOs = 0.00112821%) called our attention as Egyptian Experts Against Stroke EXPANSE group ( collection of the key-persons physician and societies in Egypt from neurology , neurosurgery and neuroradiology who are involved in the stroke trade in egypt) to establish the Egyptian stroke network , with aim to narrow the above mentioned gaps for sake of our patients with special focusing on increasing the rate of Thrombectomies for LVOs in egypt.
The Egyptian stroke network which is developed by EXPANSE group, aims to narrow the above-mentioned healthcare gaps in the stroke chain for care and treatment ,with special focusing on LVOs strokes by promoting the rate of Proper Mechanical Thrombectomies (PMT) performed for LVOs .
These Goals , from the prospective overview of the EXPANSE group, could be achieved by working on 3 main Axes
1- Increase the number of the Trained and skilled physicians who will be able to deal with stroke patients in the Golden time with special focus on the LVOs Strokes within all parts of stroke chain of care (prehospital , Hospital , and AIS workflow , performing Proper Mechanical Thrombectomy (PMT) reporting results , and planing secondary prophylaxis programs ). And in this regards the group contracted the Neurovascular Diploma which aim at increasing the capabilities of the junior neurologists , neurosurgeons and neuroradiologists to help and train them to skillfully deal with Neurovascular Diseases and on top of them Stroke patients. in this regards the 4 tiers course of that diploma , one tier (6 months) is assigned for stroke diagnosis and management and training on case scenarios of LVOs via 3D print patient specific models ( with collaboration between Alexandria University , Cairo University , Universiti Putra Malaysia (UPM) please refer to the official website of neurovascular diploma (www.neurovasculardiploma.com ) as well as hand-on through different regional fellowship programs directed through many collaborating societies.
2- Connect to Network : Where EXPANSE group sees that one important track to increase the rate of thrombectomies is through decreasing the time between onset of stroke and presentation to the Adequate facilities. Knowing that , there is a very large scale of discrepancy between different sectors related facilities in presenting the basic medical care services with absence of EMS system with clear and formal triage pathways , all these factors contribute to the massive leak of stroke patients from any system that could be constructed in this regards. This limb of the project is leveraging on innovative SECRET registry ( Stroke Egyptian Clinical REgisTry ) which is unique in its functionality where it created 2 pools of stroke practice The `State’ which act as the national measure and reference for stroke practice and `Site’ pool which is the measure of stroke practice in each registered facility. Additionally it acts as national directory for all facilities presenting this service in Egypt and classified into 6 levels of completeness of that services based on the availability of 5 bundles of stroke chain of care The main target behind this is use this data create a color-coded GPS national map for stroke facilities in Egypt. On the another side , it acts through its unique cost-effectiveness analysis tool for to be used to evaluate the workflow of all service or for special procedures to help policymakers and facility’s administrators to seize their standard operating protocols accordingly. for more details refer to the official website (www.strokeregistry.eg)
3- Publicizing the procedure : EXPANSE group as a group of experts practicing the trade since decades in the Egyptian market realize that the current inverted picture of stroke services` providers; where 16% of the total inpatient bed capacity in Egypt represented in the private sector of the medical services` providers is presenting more than 98% of of AIS services , the picture that should be corrected to maximize the stroke treatment benefit for more patients. In this regards the EXPANSE- Group foresee that figuring out the proper cost effectiveness model for mechanical thrombectomy could play a crucial rule in convincing the policymakers in the country to be one national health care priority in the statal plans for health. The overview that could make mechanical thrombectomy one of the totally reimbursed life saving procedures (TRLS procedures ) by the state; the way that could help steadily and sustainably to increase the number of MT for LVOs stroke with any instability of such increase by economical non medical policies. the group have designed the first national study named FEMTO Stroke Trial which is RCT with aim to cost-effectively analyses the importance of MT in the medical market.