BRUNEI-MUARA – A team of doctors has successfully performed the country’s first blood clot removal for a stroke patient, medical experts from the Pantai Jerudong Specialist Centre (PJSC) announced on Friday.

The procedure was carried out on 33-year old Hii Hin Chung after he collapsed from a stroke on July 13.

During a press conference at the specialist centre, medical professionals explained that Hii was brought to RIPAS Hospital by ambulance, suffering from 90 percent paralysis on the left side of his body.

On the same day, he was transferred to the Brunei Neuroscience Stroke & Rehabilitation Centre (BNSRC) where he underwent thrombolysis (a procedure to dissolve a blood clot) but doctors were concerned when his brain scan showed there was still a blockage.

Stroke survivor, Hii Hin Chung (L), with Director of BNSRC, Dr Dk Siti Nur’Ashikin Pg DP Hj Tengah (R) and RIPAS Hospital consultant radiologist, Dr Sankarakumar Sambdandamurthy (C) on Aug 10, 2018. Photo: Rasidah Hj Abu Bakar/The Scoop

Hii was transferred back to RIPAS Hospital where doctors did an angiography (medical imaging of blood vessels) and identified a 6cm clot in the patient’s brain. They decided to perform a mechanical thrombectomy — a recent breakthrough in stroke treatment where a catheter is threaded into an artery in the groin and up through the neck, until it reaches the blood clot. A stent is inserted into the catheter to stretch the walls of the artery so the blood can flow, and is “retrieved” – or pulled backwards – which removes the clot.

The procedure was performed by two RIPAS Hospital radiologists Dr Sankarakumar Sambdandamurthy and Dr Lim Kian Chair.

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Doctors said the patient has made a good recovery and is now able to manipulate objects with his left hand and walk independently. He will continue outpatient rehabilitation at BNSRC’s Neurology Clinic.

Director of the Brunei Neuroscience Stroke & Rehabilitation Centre, Dr Dk Siti Nur’Ashikin Pg DP Hj Tengah, told media that the procedure was a breakthrough for the Brunei medical community.

She said that even though the BNSRC had been using thrombolysis to treat stroke for the past eight years, it is not an effective treatment for all patients.

“They may come too late [for treatment]… and thrombolysis cannot help every single patient. Our ability to effectively help people is markedly diminished the longer they delay in going to the hospital.”

Director of BNSRC, Dr Dk Siti Nur’Ashikin Pg DP Hj Tengah (C) speaks during a press conference to announce Brunei’s first successful mechanical thrombectomy (clot removal) for stroke. Also present were PJSC Executive Director Dr Mazrul Adimin Hj Awg Besar (L) and RIPAS Hospital consultant radiologist, Dr Sankarakumar Sambdandamurthy (R). Photo: Rasidah Hj Abu Bakar/The Scoop

Thrombectomy — meaning mechanical removal of the clot — is a major advancement in stroke management that can significantly reduce the probability of death and permanent disability.

“Every facility that is able to do it has recognised the importance [of thrombectomy],” Dr Dk Siti Nur’Ashikin said. “In Brunei, it requires skills, communication and public awareness. If we can do all of these things, then we can offer the same standard of care offered in developed nations.”

What is a stroke? A stroke occurs as a result of lack of blood flow to an area of the brain due to blockage or bleeding.

The stroke centre director acknowledged there is a need for greater public awareness on the dangers of stroke, and the need for people to come to the hospital early if they exhibit the symptoms of stroke.

Stroke is the fourth leading cause of death in Brunei after cancer, heart disease and diabetes. In 2016, stroke accounted for 7.5 percent of all deaths in the country.

Dr Dk Siti Nur’Ashikin added that hypertension, diabetes, high cholesterol and smoking are all risk factors for stroke, heart diseases and cancer.

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