Research, key to designing new care processes in stroke cases

On the occasion of World Stroke Day, on October 29, the Neuroscience Research Group of the IIS Aragón, which has a specific area of ​​development in neurovascular diseases, shares some of the pioneering studies carried out in this field in Aragón

Stroke is one of the most important health problems globally. It represents the second cause of death worldwide and the first cause of permanent disability in adulthood. In Aragon, in 2022, there were 2042 admissions for this cause, constituting the first cause of death in women, in addition to having a health cost associated with disability of around 199 million euros.

Data like the previous ones confirm the importance of the investigation, aimed at better knowledge, care and management of this pathology, it is crucial within the health system of our Autonomous Community. In this sense, the Neuroscience Research Group of the IIS Aragón, led by Dr. Javier Marta, has a specific area of ​​development in neurovascular diseases and on the occasion of World Stroke Day, Dr. Herbert Tejada, coordinator of said area, tells us about the studies that have been carried out and are being carried out in this field.

In recent years, research regarding the acute management of ischemic stroke in Aragon has been consolidated as a multidisciplinary and interhospital development field, focused on improve attendance. Thanks to its comprehensive approach, it has been possible to incorporate its results into a system of continuous improvement, seeking to develop health strategies adapted to the specific characteristics of Aragon. “We believe that it is essential to know and compare our results in order to improve them. Thus, we were able to quickly adapt to the challenge of maintaining stroke care during the COVID pandemic (with several publications on the matter in international journals) and in the last 5 years managed to increase the rate of patients treated per year by mechanical thrombectomy by 55%, achieving also significantly improve the results obtained in the functional prognosis of these patients,” notes Herbert Tejada. In the case of other available reperfusion treatment, intravenous fibrinolysis, it has been possible to design a care process with which more than half of the patients who receive this treatment can do so in less than 45 minutes from their arrival at the Emergency Department (compared to close to 10% of them who was what happened previously), which is of special relevance in pathologies such as stroke, whose results are time dependent.    

In regards to the study of ischemic stroke in young adults (people under 50 years of age), Aragón has the largest study cohort in Spain, currently made up of 1213 patients, whose analysis has allowed us to obtain relevant data such as the fact of having detected an increase in the annual rate of hospital admissions/ 100000 inhabitants, going from 11,5 in 2015 to 15,5 in 2020. A prevalence of cancer six times higher than that described for their age group in Spain has also been observed in this cohort.

Diagnosis and treatment of unusual diseases is often a challenge in medical practice., Moyamoya angiopathy is one of the neurovascular diseases belonging to this group. The work titled “Moyamoya in Aragón: epidemiology and self-perceived quality of life” (which will soon be published in Neurology Magazine) will become the only indexed work that assesses the prevalence of this entity in a Spanish autonomous community. In this study, in addition to finding a prevalence up to three times higher than expected in Aragon, the self-perceived health of these patients has been assessed, a fundamental aspect to guarantee personalized healthcare. “This study also allowed us to collect fundamental information to design a care circuit (currently launched) that provides comprehensive and equitable multidisciplinary care to patients with this pathology throughout the Autonomous Community,” highlights Dr. Tejada.

Vascular dementia is the second most common form of dementia, after Alzheimer's disease, and having a stroke doubles the risk of suffering from it. The neurocognitive sequelae of stroke are often more disabling than the physical limitation. Not all individuals who have a stroke will develop dementia or cognitive impairment, but they are very common. Knowing the factors that increase this risk is very important and are those that are investigated in the IctusCOG patient cohort, to which hospitals from other Autonomous Communities such as Madrid, the Basque Country and Navarra have joined. This cohort is the only Spanish one among the more than 30 included in the international StroKog initiative. Currently, there is data from approximately 60 patients, hoping to reach 300, and the initial results of the analysis of this cohort will be presented at the next European Congress of Neurovascular Diseases.

In addition to the lines of research previously described, the Neurosciences research group is involved in R&D projects financed by the Carlos III Institute and participates in different national and international clinical trials that contribute to the development of knowledge in neurovascular pathology. We are also starting biosignal analysis projects in collaboration with the Bsicos group of the School of Engineering in addition to being part of national research networks such as RICORS – ICTUS and strategic alliances such as those of the NORDICTUS group that covers 8 Autonomous Communities in the North of Spain .