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Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

author:Physician Journal

Author: Rong Media reporter Song Zhen

Stroke treatment is related to personal health and family happiness. In the process of acute ischemic stroke gradually becoming a major threat to national health, Aitonli has opened up a way to protect the lives of stroke patients and witnessed the transformation of Stroke Treatment in China in the past 20 years. In 2021 alone, more than 270,000 patients benefited from Atonli thrombolysis. On September 3rd, the "Time Flying Hand in Hand" Aitongli Intravenous Thrombolytic Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held in Shanghai, Suzhou and Hangzhou.

Shanghai venue

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held
Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

The guests attending the launch session at the Shanghai venue were Professor Dong Qiang of Huashan Hospital affiliated to Fudan University, Professor Liu Xueyuan of Shanghai Tenth People's Hospital, Professor Zhao Yuwu of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Professor Li Gang of Shanghai Dongfang Hospital, Professor Cheng Xin of Huashan Hospital Affiliated to Fudan University, Professor Han Yan of Shanghai Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Professor Yue Yunhua of Yangpu Hospital Affiliated to Tongji University, and Ms. Pan Liangbing, Head of Marketing in the Field of Central Nervous System and Respiratory Therapy at Boehringer Ingelheim.

Suzhou venue

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held
Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

The guests attending the launch session at the Suzhou venue were Professor Liu Chunfeng of the Second Affiliated Hospital of Soochow University, Professor Zhou Junshan of the First Hospital of Nanjing, Professor Wu Jin of the Second Affiliated Hospital of Nanjing Medical University, Professor Liu Ying of Taizhou People's Hospital, Professor Cai Xiuying of the First Affiliated Hospital of Soochow University, Professor Zhai Wanqing of the First People's Hospital of Taicang City Affiliated to Soochow University, Professor Wang Wanhua of the First People's Hospital of Kunshan City, and Professor Pei Shaofang of the North District of Suzhou Municipal Hospital.

Hangzhou venue

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held
Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

The guests attending the launch session at the Hangzhou venue were Professor Lou Min of the Second Affiliated Hospital of Zhejiang University School of Medicine, Professor Xie Guomin of Li Huili Hospital of Ningbo Medical Center, Professor Chen Hongfang of Jinhua Central Hospital, Professor Zhang Xiaoling of Jiaxing Second Hospital, Professor Wang Yaxian of Huzhou Central Hospital, and Professor Cai Xueli of Lishui Central Hospital.

Ms. Chen Xingrong, Senior Vice President and Chief Marketing Officer of Boehringer Ingelheim, and Ms. Pan Liangbing, Head of Marketing in the Field of Central Nervous System and Respiratory Therapy at Boehringer Ingelheim, made an opening speech and said that in the past 20 years, with the joint efforts of many experts and scholars in China, from the stroke unit to the stroke center, from the "time window" to the "organization window", from the stroke green channel to the stroke emergency map, China's stroke treatment level has reached a new level, achieving all-round three-dimensional progress, providing millions of Chinese stroke patients with more rapid, A more perfect stroke treatment system has also brought more possibilities for stroke patients to recover their health, return to their families, and return to society.

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

Ms. Chen Xingrong (left) and Ms. Pan Liangbing (right) delivered opening remarks

As a global leader in stroke treatment, Boehringer Ingelheim will make full use of the advantages of the professional field, patient-centered, continue to increase cooperation with the government, societies and experts, provide patients with more diversified choices and solutions, and promote innovation and development in the field of stroke in China.

Messages from experts of the Bureau

Usher in a new era of stroke treatment and move towards a higher level

Professor Dong Qiang of Huashan Hospital Affiliated to Fudan University and Professor Liu Xueyuan of Shanghai Tenth People's Hospital were invited to serve as the chairmen of the conference; Professor Liu Chunfeng of the Second Affiliated Hospital of Soochow University and Professor Zhou Junshan of the First Hospital of Nanjing Were specially invited to serve as the chairmen of the conference; Professor Lou Min of the Second Affiliated Hospital of Zhejiang University School of Medicine and Professor Chen Hongfang of Jinhua Central Hospital were specially invited to serve as the chairmen of the conference.

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held
Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held
Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

Professor Wang Feng of Shanghai Seventh People's Hospital, Professor Zhang Xuting of the Second Affiliated Hospital of Zhejiang University and Professor Wu Jin of the Second Affiliated Hospital of Nanjing Medical University co-chaired the meeting.

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

From left: Professor Wang Feng, Professor Zhang Xuting, Professor Wu Jin

Professor Dong Qiang pointed out in his speech that the quality of stroke medical services in mainland China has changed dramatically in the past 20 years. The rate of thrombolysis in the time window of acute stroke has risen from 1% to 30%, and will exceed 50% in the future, moving towards higher levels. In the future, it is hoped that thrombolytic therapy will be further popularized, benefiting more patients, so that thrombolysis will become the basic standard and normal treatment of the industry, and patients cannot miss the opportunity of "golden time" treatment.

"Ai Tong Li thrombolysis opened a new era of stroke treatment." Professor Liu Chunfeng said that in 2007, the Second Affiliated Hospital of Soochow University established a stroke ward and gradually changed the concept of treatment, which brought greater benefits to patients. In the past decade, Suzhou has made remarkable progress in the treatment of intravenous thrombolytic stroke, which has also led to the development of other technologies such as arterial embolism and arterial stents. Of course, this is also inseparable from the strong support of Atonli and Boehringer Ingelheim for many years.

Professor Lou Min said that this year is the 20th anniversary of Stroke Treatment in China and the 10th anniversary of stroke quality control in Zhejiang Province. In the past 10 years, the volume of thrombolysis in hospitals in Zhejiang Province has increased rapidly, and it will become the norm in the future. In the promotion of thrombolysis work, the construction of stroke centers is particularly important, and its systematization, processization and standardization all play a major role in improving the level of treatment. It is hoped that Boehringer Ingelheim will continue to work with Chinese experts to bring about quantitative changes with every exchange and every sharing, and then achieve qualitative changes.

Impression • Highlight Era

The Chinese gold standard for thrombolytic therapy

Over the past 20 years, Together with Chinese cerebrovascular disease doctors, Atonli has established the Chinese gold standard for thrombolytic therapy, opening the highlight era of vascular recantherapy. Professor Cheng Xin of Huashan Hospital affiliated to Fudan University brought a wonderful lecture on "Stroke Treatment, Pioneer of the Times - Alton Li and China Stroke Treatment for 20 Years", introducing the 20-year process of Alton Li (alteplase for injection, rt-PA) with Stroke Treatment in China. She pointed out that Aitongli is a product of the era of stroke treatment, which has greatly promoted the development of stroke diagnosis and treatment in China.

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

The latest epidemiological survey shows that the mainland still faces a heavy burden of stroke, with about 28.76 million stroke patients. Once a stroke is developed, the time is the brain, and stroke treatment loses 32,000 neurons every 1 second delayed. Among the various treatments, intravenous thrombolysis is the most effective and important treatment for improving acute ischemic stroke (AIS) reperfusion. With the development of society and the progress of medical technology, the rate of intravenous thrombolysis in mainland China has increased significantly in recent years, but there is still a gap with developed countries. The relevant policy lists "improving the rate of acute cerebral infarction reperfusion treatment" as one of the ten major improvement goals of medical quality and safety in mainland China, and is also the focus of medical quality control that the country is concerned about.

The emergence of rt-PA has further met the needs of patients for intravenous thrombolysis and also brought a powerful therapeutic "weapon" to physicians. NINDS research has opened up a new era of thrombolytic therapy for acute ischemic stroke, which shows that rt-PA significantly improves prognosis and reduces the risk of disability at 90 days by at least 30%, extend and other studies have confirmed that under the guidance of multimodal imaging, the thrombolytic time window has been pushed from 4.5h to 9h, so that thrombolytic therapy has benefited more AIS patients.

To this day, rt-PA is still the only fibrin-specific thrombolytic agent approved for AIS treatment, and it is also the only thrombolytic drug recommended by domestic and foreign authoritative guidelines Class I, and its importance is self-evident.

Seal • Stable as Tarzan

A new era of thrombolytic therapy

Professor Zhang Xiaoling of jiaxing Second Hospital shared the theme report of "Talking about stroke, evidence is king - new progress in the treatment of ischemic stroke reperfusion drugs".

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

Professor Zhang Xiaoling pointed out that biosimilars refer to biological products approved by regulatory agencies based on the similarity arguments of the original drugs in terms of quality, safety and efficacy.

If no bioequivalence studies were conducted with the original TNK, the clinical evidence of the original TNK cannot be cited. It should be noted that at present, no domestic TNK has conducted any studies to confirm that it is a biosimilar of the original TNK, so it cannot extrapolate the effectiveness and safety of the global clinical research of the original TNK to the domestic TNK, nor can it use the clinical research data of the original TNK to prove its safety and efficacy.

Based on a number of domestic and foreign research results, the current guidelines mainly make TNK-related recommendations in patients with LVO and mild stroke, and the relevant evidence is based on the original research TNK. For the treatment of patients with AIS, domestic and foreign guidelines still recommend rt-PA in Class I, and AIS indications are obtained. Neither TNK nor TNK has yet to obtain indications in the field of AIS.

In this context, can TNK be used for thrombolysis in AIS patients with super indications? Professor Zhang Xiaoling stressed that the new version of the "Physician Law" for the first time clearly pointed out the approval conditions for exceeding the instructions, stipulating that doctors choose to use drugs must be drugs approved in accordance with the law, and follow the special circumstances such as no effective or better treatment methods, the use of drugs has evidence-based medical evidence, obtains the clear informed consent of patients, and the four principles of hospitals establishing management systems and reviewing appropriateness.

At present, all guidelines at home and abroad unanimously recommend rt-PA for AIS, and TNK ultra-indication drugs do not meet the provisions of the new Physician Law and bear legal risks.

Inchi Shine Starlight

Classical medicines are still the mainstay of thrombolytic therapy

The original research TNK has risen sharply in recent years, and it is also stepping towards the forefront of AIS diagnosis and treatment, it can be said that TNK is a bright light, but further tests are still needed to confirm. Professor Pei Shaofang of the North District of Suzhou Municipal Hospital pointed out in the theme report of "Looking to the Future, Basing on the Present - RT-PA is the Global Gold Standard for AIS Thrombolysis" that as a classic drug for thrombolysis, rt-PA is still the gold standard for AIS thrombolysis.

Riding on the storm of the times, guarding China's stroke patients for 20 years | Atoni Venous Thrombolysis Summit Forum and 20 Years of Stroke Treatment in China (East China Station) were held

At present, the phase II study of the treatment of AIS by the original TNK mainly focuses on safety and dose comparison, and the phase III study is underway, and the original TNK has not yet obtained AIS indications. Now, guidelines consider tenectaplase only for patients with mild neurological deficits without intracranial macrovascular occlusion (IIb) and patients with large-vessel bridging therapy (IIb), all of which are derived from the original study TNK.

New drugs are still experimental, and classic drugs are still the main force in thrombolytic therapy. RT-PA is the only AIS gold standard supported by more than 25 years of solid evidence-based medical evidence. The risk ratio of benefits of rt-PA intravenous thrombolysis exceeds 10 times, and the authoritative guidelines at home and abroad are consistent with Class I to recommend alteplase intravenous thrombolysis for PATIENTs with AIS within 4.5 hours of onset.

Although stroke has been well known and valued by many people, mild stroke is easily overlooked because of its mild symptoms. Professor Pei Shaofang pointed out that there are major hidden dangers in light stroke and must be taken seriously. China's National Stroke Register III shows that mild stroke (NIHSS score ≤3) accounts for 51.7% of the population with ischemic stroke. Mild stroke has a high proportion of recurrence and disability and can progress to disabling stroke. Studies have shown that patients with mild ischemic stroke who have not received thrombolytic therapy are more likely to have functional decline at 30 to 90 days, which once again clarifies the thrombolytic status of rt-PA and warns doctors and patients to dissolve thrombolysis in time for mild stroke, and the prognosis will be better and the quality of life will be higher.

The controversy of direct embolic retrieval VS bridging therapy has never stopped, the results of the relevant 6 major RCTs are inconsistent, and there are differences in the study design, and whether it can be generalized to the real world is debatable. Professor Pei Shaofang pointed out the overly wide non-inferior efficacy cut-off value, and the influence of DNT time delay on the benefit of intravenous thrombolysis. Combining the results of multiple studies, bridging therapy shows better vascular recanalization rate, better functional prognosis rate during hospitalization and lower mortality, which is the best choice for LVO patients. Professor Pei Shaofang stressed that according to the latest global guidelines, endovascular therapy should be based on alteplase intravenous thrombolysis.

Discussion and conclusion

Explore new technologies and methods that can benefit patients more

In the talk-and-talk session, Professor Dong Qiang, Professor Li Gang, Professor Zhou Junshan, Professor Zhai Wanqing, Professor Wang Wanhua, Professor Xie Guomin, Professor Wang Yaxian, Professor Chen Hongfang, Professor Zhang Xiaoling, Professor Liu Xueyuan, Professor Yue Yunhua, Professor Liu Ying, Professor Cai Xiuying, Professor Liu Chunfeng, Professor Pei Shaofang, Professor Cai Xueli, Professor Zhao Yuwu, Professor Cheng Xin, Professor Han Yan made achievements in the treatment of cerebrovascular disease in China, as well as the construction of stroke treatment network circles and stroke centers. Extensive and in-depth discussions and exchanges were held on hot spots and focal issues in the fields of stroke treatment network construction.

Presidium experts Professor Liu Xueyuan, Professor Chen Hongfang, Professor Zhou Junshan summed up the conference and pointed out that in the past 20 years, Atonli's contribution in the field of intravenous thrombolysis has been "unprecedented, no one has come after", and the mainland has made many achievements in the field of stroke treatment, facing the future, to explore new technologies and methods that are more suitable and more able to benefit patients.

Professor Dong Qiang pointed out in the final summary of the conference that on the basis of the theory of "time is the brain", Aitongli has accompanied Chinese clinicians for 20 years. As the gold standard within the time window of intravenous thrombolysis, Atonli will bring great benefits to the mainland as soon as possible. We should consolidate the popularization and application of rt-PA in primary medical institutions earlier and more comprehensively, and widely carry out vascular recantherapy. In the future, we will further improve the construction of stroke centers and treatment centers according to local conditions, and meet and embrace new concepts such as "organization is the brain", so as to further enhance the ability of vascular re-access services, and then provide more comprehensive services for society!

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