DOCUMENT

4 Headlines B ut, if you do, it may be reassuring to know that you are probably in one of the best places in the world and at the best point in history to suffer from a stroke. “New Zealand is well advanced in providing stroke treatment and rehabilitation, and a huge reason for that is the support we have received from the Neurological Foundation,” says Professor Barber. Since he was appointed as the Chair of Clinical Neurology in 2008, Professor Barber has been instrumental in significantly improving the management and care of stroke patients in New Zealand. A recent milestone was his involvement in establishing New Zealand’s first dedicated hyperacute stroke and rehabilitation unit at Auckland City Hospital, Taiao Ora. Opened only 18 months ago, Taiao Ora, on Ward 51, enables stroke patients to have all their care delivered in one specially designed facility, with some of the most well- trained clinicians (doctors, nurses, and allied health staff) and advanced treatments in the world. “Before we had this facility, stroke patients would be admitted to one ward for hyperacute care, then shifted to another for initial investigations, and then to another for rehabilitation – sometimes in a different hospital,” Professor Barber says. “Now it’s like a one-stop-shop. Stroke patients come into the specialist hyperacute unit at one end, and then rehabilitation further along the ward, and we do everything we can to ensure they come out the other end ready to go home.” While Professor Barber focuses on immediate treatment to reduce the brain damage that stroke can cause, rehabilitation after stroke is the other critical factor in the patient journey and is integrated into the unit. [Read about Professor Cathy Stinear’s world-leading stroke rehabilitation research on page 8.] “The research teams are embedded in the ward, and the different streams of research can come together. It’s fantastic, it facilitates the sharing of ideas, and it must be almost unique in the world.” As soon as a stroke patient arrives in hospital, they are assessed for suitability to receive one or both brain-saving treatments – either the clot-busting drug alteplase or stroke clot retrieval, where the clot causing the stroke is pulled out of the artery. The drug alteplase was the first-ever stroke treatment that could reduce the damage caused by stroke and was introduced in the 2000’s when Professor Barber returned from his Neurological Foundation-funded PhD studies at the University of Melbourne and Royal Melbourne Hospital. The drug has been incredibly successful. However, it does have limitations. To begin with, only patients who arrived within the ‘golden window’ of 4.5 hours from the onset of symptoms were initially able to receive the therapy. This obstacle inspired a second pivotal study, the EXTEND trial, which aimed to broaden this window. Professor Barber was part of the international team that showed advanced brain scanning techniques can identify patients who can still benefit from alteplase after 4.5 hours had elapsed or if the time of the onset of symptoms was unknown. “That was an absolute game-changer. It has opened up alteplase therapy to many more people worldwide that would have previously been denied treatment.” But the most significant new stroke treatment is clot retrieval. Professor Barber was part of the team on one of the five pivotal international studies published in 2015, showing what a game-changer this therapy is. His research since this time has been focused on streamlining and perfecting this therapy. During a stroke clot retrieval, a microcatheter is inserted into one of the large arteries in the groin and gently advanced (“pushed”) along the aorta and into the arteries supplying the brain. The clot is located using artery scanning techniques, and a mesh-type stent device is used to capture the clot and pull it out. So far, 1200 patients across New Zealand have been treated with this procedure. When we spoke to Professor Barber, 20 had been performed at Auckland Hospital the previous week, their busiest week ever. Busy clot retrieval centres also operate in Wellington and Christchurch, where patients from central and southern New Zealand are treated. For every three people who receive the clot retrieval treatment, one is saved from a life of ongoing disability. “That means there are now 400 kiwis who have been given a second chance at life. If their stroke happened five or seven years ago, the outcome would have been very different.” “New Zealand was one of the first cabs off the rank to introduce clot retrieval,” Professor Barber adds. “Because Taking on one of New Zealand’s biggest killers First and foremost, Professor Alan Barber does not want you to have a stroke. Strokes are bad. They are the second leading cause of death in New Zealand, and as our population grows and ages, the number of New Zealanders having strokes is on the rise.