Brunei makes history with first clot removal for stroke

|     Azaraimy HH     |

BRUNEI made history on July 13 when the first successful mechanical thrombectomy (clot removal) for stroke was performed in the country.

The complicated medical procedure was carried out on Hii Hin Chung, 33, in a collaborative effort between the Brunei Neuroscience Stroke and Rehabilitation Centre (BNSRC) and the Radiology Department of the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Ministry of Health.

With this, the life-saving medical option would be available for stroke patients in the country.

Hii Hin Chung was present at a press conference to announce the success of the surgery yesterday at the Pantai Jerudong Specialist Centre (PJSC), and could be seen recovering quite well. Present during the press conference to share the outcome of the operation and explain about stroke problems were Executive Director of PJSC Dr Mazrul Adimin bin Haji Awang Besar; Director of BNSRC and Consultant Neurologist Dr Dayangku Siti Nur’Ashikin binti Pengiran Dato Paduka Haji Tengah; and Consultant Radiologist at RIPAS Hospital Dr Sankarakumar Sambandamurthy.

According to PJSC, Hii, a car parts salesman, was found with left-side weakness at 2.30pm on July 13 by work colleagues.

Executive Director of PJSC Dr Mazrul Adimin bin Haji Awang Besar; Director of BNSRC and Consultant Neurologist Dr Dayangku Siti Nur’Ashikin binti Pengiran Dato Paduka Haji Tengah; and Consultant Radiologist at RIPAS Hospital Dr Sankarakumar Sambandamurthy at the press conference yesterday. – AZARAIMY HH

He was brought to the RIPAS Hospital by ambulance and was subsequently transferred to BNSRC where scans confirmed a stroke on the right side of his brain.

Clot-busting treatment (thrombolysis) was given initially with good effect, however, there was concern as his brain scan showed a blockage to blood flow.

The patient was escorted to RIPAS Hospital by Neurology Medical Officer at BNSRC Dr Chan Guan Choon who reported that Hii’s speech was slurred and his left arm and leg were both weak.

At the RIPAS Hospital, Hii underwent angiography carried out by Dr Sankarakumar, assisted by Consultant Radiologist and Head of the Department of Radiology Dr Lim Kian Chai. They identified a long clot which they were able to extract using a special suction device.

Hii was then transferred back to BNSRC where he was monitored initially at the Neuro-Intensive Care Unit before being moved to the Neurology Ward for further treatment and rehabilitation. Hii made a good recovery and on discharge he was able to manipulate objects with his left hand well and was able to walk independently. He continues to have outpatient rehabilitation and will be followed up in the Neurology Clinic.

Dr Dayangku Siti Nur’Ashikin added, “This is a great example of successful stroke treatment through early action, skilled workforce and good cooperation between healthcare institutions in Brunei Darussalam …We are extremely grateful to the Government of His Majesty Sultan Haji Hassanal Bolkiah Mu’izzaddin Waddaulah ibni Al-Marhum Sultan Haji Omar ‘Ali Saifuddien Sa’adul Khairi Waddien, Sultan and Yang Di-Pertuan of Brunei Darussalam for supporting such endeavours that directly benefit patients needing treatment for stroke.”

BNSRC and the Ministry of Health continue to work closely together in efforts to combat stroke and later this year plan to launch a campaign targetted at stroke prevention as well as treating stroke early, she added.

In the press conference, the Director of BNSRC shared, “Stroke occurs as a result of lack of blood flow to an area of the brain either due to a blockage from a clot (ischemic stroke) or through bleeding into the brain (haemorrhagic stroke).

The main risk factors for stroke are high blood pressure (hypertension), high cholesterol, diabetes mellitus, smoking and family history.

“Stroke (or cerebrovascular diseases) has been recorded as the fourth leading cause of death in Brunei Darussalam (after cancer, heart disease and diabetes mellitus) from 2012-2016, according to national health statistics published by the Ministry of Health. In 2016, stroke accounted for 7.5 per cent of all deaths in the country.

“However, perhaps of even greater significance is the impact caused by disability as a result of the stroke. This could include weakness of limbs, loss or impairment of speech. The resultant disability is evident in the burden of care as well as loss of employment/income, either through having the stroke or being the stroke-carer.

“The impact of stroke, not just on the individual but also the community, should be taken very seriously …While we always advocate for stroke prevention, once a stroke has happened, I urge patients to attend hospital emergency department as soon as possible because the faster we are able to treat a stroke, the more likely our treatment will be effective … Treatment decisions do depend on stroke type but thrombectomy offers an exciting, new option for stroke treatment that can significantly reduce not just death but also disability,” she said.