FOR STROKE patients, every minute of delayed treatment can mean irreversible brain damage. The first cerebral mechanical thrombectomy performed at UST Hospital marks a major step in expanding access to life-saving stroke treatment for patients with blocked major brain arteries.
The procedure, carried out through the hospital’s stroke service and Rapid Ultrasound in Shock (RUSH) team, restored blood flow by removing a clot from a blocked brain artery before more brain tissue could die from lack of oxygen.
Dr. Francis Angelo Basilio, who led the procedure with Dr. Emmanuel Almazan, said mechanical thrombectomy is used for patients with large vessel occlusion, in which a major artery supplying blood and oxygen to the brain becomes blocked by a clot.
“Malaking artery siya, malaking part ng brain ‘yung puwedeng mamatay. Pag walang ginawa, malaking symptoms ‘yung mararamdaman ng patient. It can lead to disability or even death,” Basilio told the Varsitarian.
The patient was quickly assessed upon arrival at the emergency room and underwent CT (Computed Tomography) scan to determine whether the brain tissue could still be saved and whether a major artery was blocked.
“Nung na-assess namin na large vessel occlusion talaga siya at kaya naming gawin ‘yung thrombectomy, we quickly brought the patient to the Cath Lab para magawa ‘yung [procedure],” Basilio said, referring to the hospital’s catheterization laboratory, where minimally invasive procedures are performed using imaging-guided instruments
The procedure used the Penumbra Aspiration System, which removes clots by suction through a thin tube, or catheter, inserted through a puncture near the groin and guided through blood vessels toward the blocked artery in the brain.
The team restored blood flow 12 minutes after activating the Penumbra engine, aspirating the clot in two passes, or two attempts, to remove the blockage.
“Time is brain,” Basilio said. “The faster that we manage this patient, the faster that we can revascularize the brain, the better chance of a better outcome.”
According to the Stroke Society of the Philippines, stroke is the country’s second leading cause of death. Ischemic strokes, which happen when blood flow to the brain is blocked, account for about 70% of cases, while hemorrhagic strokes, which involve bleeding in the brain, make up the remaining 30%.
Basilio said mechanical thrombectomy is mainly used for ischemic strokes involving large vessel occlusions, which are often too severe to be treated by thrombolysis, a clot-dissolving drug treatment administered through medication.
While thrombolysis costs about P60,000 to P70,000 per vial, Basilio said thrombectomy devices alone may cost about P500,000. Most patients still pay out of pocket because mechanical thrombectomy is not commonly covered by health maintenance organizations or PhilHealth.
Basilio said the Philippines remains behind neighboring countries in access to thrombectomy. He cited Vietnam, which performs about 2,000 thrombectomy cases a year, compared with fewer than 100 cases annually in the Philippines.
Only about 19 specialists nationwide perform the procedure, leaving many regions without access to the intervention.
Other barriers include delayed hospital arrival, low public awareness of stroke symptoms, poor emergency transport systems, limited imaging facilities, lack of catheterization laboratories, and uneven hospital workflows.
He said patients should recognize the “FAST” symptoms of stroke: “facial drooping, arm weakness, speech difficulty, and time to seek emergency care.”
“Ideally, patients should be [brought to emergency care] within six hours. It can extend up to 24 hours. Pero the best pa rin talaga is madala sila as soon as possible kasi pag patay na ‘yung brain, wala na kaming magagawa,” Basilio said.
The recipient of UST Hospital’s first thrombectomy was an 81-year-old patient who had lost movement on the right side of the body, a common symptom of stroke caused by disrupted brain function.
After the procedure, the patient regained partial movement and responsiveness, though recovery remains ongoing because of age and existing comorbidities or other medical conditions.
Basilio said the procedure was not the work of one physician but of the hospital’s stroke service and RUSH team, which developed the workflow for assessment, imaging, team activation, and transfer to the catheterization laboratory.
“So it’s not just a one-man team. It’s the RUSH team ng UST talaga ‘yung nag-plan out kung papaano ‘yung workflow, paano i-assess ‘yung patients, paano i-activate ‘yung buong team, [at] paano maipadala sa Cath Lab,” he said.
UST Hospital is now aiming to become a mechanical thrombectomy hub for smaller hospitals in the area through a hub-and-spoke model, enabling stroke patients who need advanced intervention to be transferred there more quickly.
