Prospects from a topic

(Baonghean) - “About three years ago, when interventional vascular techniques were not yet available in Nghe An, as doctors at the province's leading hospital, we often witnessed patients suffering from paralysis, coma… due to cerebral vascular malformations coming here for emergency treatment. For these patients, we usually had to refer them to higher-level hospitals. The transfer was fraught with anxiety, knowing for sure that the patient would die en route, or if they reached a central-level hospital, it would be too late and little intervention could be done… And from that anxiety and concern, we chose to bring endovascular intervention to the provincial hospital. This is also the first provincial-level hospital to implement such a difficult technique.”

Dr. Duong Dinh Chinh, Deputy Director and Head of the Neurology Department at Nghe An Friendship General Hospital, told us this before discussing the scientific project he and Dr. Nguyen Tat Thang, which won second prize in the 2013 Provincial Science, Technology and Innovation Award, was undertaking. “Recently, the hospital had two projects awarded second prize: the project: ‘Treatment of gastric cancer by endoscopic surgery with lymph node dissection’ by Dr. Nguyen Van Huong and his colleagues, and our project: ‘Treatment of cerebral vascular malformations by endovascular intervention at Nghe An Friendship General Hospital.’ What’s even more noteworthy is that, in reality, when we carried out these projects, many people with serious illnesses were saved right in their hometowns, without having to travel far, enduring hardship and expense. And the term ‘referral’ has gradually become less common at a provincial hospital that is striving for regional prominence,” Dr. Duong Dinh Chinh added.

Dr. Duong Dinh Chinh (center) receives the 2013 Science, Technology and Innovation Award.

As Head of the Neurology Department for many years, Dr. Duong Dinh Chinh has witnessed thousands of cases of cerebral hemorrhage each year, with hemorrhage due to cerebral vascular malformations being the leading cause of danger due to its complications and the almost constant risk of recurrence if the malformation is not thoroughly treated. However, it is a silently progressing disease, and it is often only detected when the vascular malformation ruptures.

Previously, the treatment for cerebral aneurysms involved surgical clipping of the aneurysm neck. For arteriovenous malformations, the treatment was surgical resection and radiotherapy. However, these methods were often not completely effective due to minimal intervention in brain tissue, resulting in a high rate of post-surgical complications, not to mention prolonged postoperative recovery time and a high risk of infection.

Endovascular intervention has proven to be superior to the aforementioned methods. Endovascular intervention involves placing metal coils to coagulate and completely seal the aneurysm lumen; using biological glue to seal the arteriovenous malformation, blocking the draining vein while ensuring the blood flow of the blood vessels carrying the malformation. Specifically, doctors will use a small catheter inserted into the patient's femoral artery. The catheter will follow the abdominal aorta to the neck, and then doctors will use another small catheter, connected to the first, to guide it up to the cerebral arteries. There, they will image the main feeding branches of the malformation, and use glue to seal the bleeding blood vessels. This method has been implemented with high effectiveness in several major hospitals such as Bach Mai Hospital, Military Central Hospital 108, and Hospital 115 in Ho Chi Minh City.

This is a difficult and complex technique requiring adequate facilities, equipment, and skilled doctors; therefore, provincial hospitals are still very hesitant to implement it. As a large province with over 3 million inhabitants, located far from central hospitals, the number of patients with cerebrovascular diseases has increased significantly in recent years. Implementing endovascular intervention for treating cerebral vascular malformations in our province is therefore essential. Thanks to the hands-on guidance of medical experts from Bach Mai Hospital in Hanoi, this technique is now being gradually transferred to the provincial hospital.

Over the past nearly three years, almost 60 patients have recovered after just two days of cerebral vascular intervention and have returned to their normal lives. Their own good fortune, and above all, the dedication of the doctors, has moved them beyond words. Patient Le Van Hue, from Thach Son, Anh Son, is one of them. Dr. Nguyen Tat Thang recounts that this was a particularly impressive case for him, due to the patient's extreme poverty. He was diagnosed with cerebral arteriovenous fistula. The pain and paralysis had left him a frail, mobile skeleton. Complete treatment would cost hundreds of millions of dong, a sum even 1 million dong was difficult for his family. The doctors and nurses in the Vascular Intervention Department helped him by utilizing existing medications and dividing the treatment into smaller sessions so he could benefit from insurance. Thanks to this, he escaped death. For him, the doctors at the clinic have become like "family," people to whom he will be deeply grateful for the rest of his life.

One patient that the doctors in the Interventional Cardiology Department will never forget is Tran Van Khanh from Nghi Phuong, Nghi Loc. He's remembered not only for his impoverished family but also for his young age, only 16. One day, after returning from school, Khanh experienced a headache, dizziness, and then fainted. Diagnosed with a stroke due to a cerebral vascular malformation, he underwent interventional cardiology to save his life. The cost was 60 million dong, a large sum for his mother, a farmer, and his father, a construction worker. Ultimately, thanks to the help of the community and the doctors, he recovered after two days of intervention.

The scientific work of doctors Duong Dinh Chinh and Nguyen Tat Thang is based on meticulous and serious research, stemming from the authors' own concerns as doctors who directly treat and handle cases daily. It not only provides a comprehensive scientific view of the disease and the advancements in treatment to date, but the novelty of the topic lies in the specific research and analysis of the application and treatment using this new technique at the provincial hospital. The work has demonstrated the practical effectiveness and prospects of a method for treating cerebral vascular malformations.

Accordingly, this treatment method can be transferred and implemented in all hospitals in the region, provided they have digital subtraction angiography (DSA) machines and staff with basic training in neurovascular intervention. The number of patients requiring this treatment at Nghe An Friendship General Hospital is approximately 60 per year. This includes patients from within the province as well as from neighboring provinces such as Ha Tinh, Quang Binh, and Quang Tri. Each patient undergoing this procedure in Nghe An would save approximately 40-50 million VND.

“Every scientific project must ultimately demonstrate a prospect for practical application. Thus, the hope that patients with cerebral vascular malformations would no longer need to be referred to higher-level hospitals, a source of anguish for doctors, has become a reality. This is the greatest joy, not only for the patients,” shared Dr. Duong Dinh Chinh. And we agree with him that striving to improve the skills and qualifications of doctors to better serve patients is also an element of medical ethics.

Text and photos:Q. Lam