Feature: Bringing stroke patients back from the brink

Has your stroke hospital implemented these protocols? If not, YOU DON'T HAVE A FUNCTIONING STROKE HOSPITAL!

Feature: Bringing stroke patients back from the brink

BEIJING, Dec. 26 (Xinhua) -- Wang Yongjun speaks unhurriedly, but he acts fast at work -- he is an experienced neurologist who has dedicated 40 years in a race with time to save patients with acute brain emergencies.

Most of his patients are victims of strokes. These occur when oxygen-rich blood flowing to the brain becomes blocked by a clot or a blood vessel bleeds into the brain. Symptoms include weakness in the face and limbs, confusion and trouble speaking. Strokes are among the leading causes of death and disability worldwide.

Acting fast and getting treatment in time can help save lives, but most patients will inevitably suffer recurrences after their first stroke, each one bringing them closer to death.

Wang's job is to bring the patients back from the brink, and over the past decade, he has conducted extensive and fruitful research that has helped him reduce the risk of recurrences among his patients.

THE 21-DAY RULE

Among his most significant contributions is the "21-day rule." He found that the use of a dual-antibody treatment (aspirin plus clopidogrel) for 21 days can be more effective in reducing the risk of early stroke recurrence than prescribing aspirin alone.

The discovery is the result of a three-year large-scale study that Wang and his team carried out, starting in 2009. Over 20,000 patients worldwide were screened, with more than 5,000 cases from 114 Chinese hospitals included in the trial.

Based on the huge amount of patient data, Wang's team built a computing model and finally created this dual-antibody therapy, which can lower the recurrence rate from 11 percent to 8 percent. The treatment could prevent hundreds of thousands of patients each year from having a life-threatening secondary stroke.

The study, "Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events," was given the shortened name "CHANCE" based on its initials.

In October 2012, Wang submitted a paper on the CHANCE study to The New England Journal of Medicine (NEJM). However, the editors did not accept it immediately. Before Wang's research, a series of double-antibody studies had been conducted internationally, but none had been successful.

In the first few rounds of review, the journal's editorial department sent Wang a host of questions and kept asking his team to submit additional materials.

"Our paper was only six pages long, but we spent 86 pages answering the questions they raised," Wang recalled. Eight months after submission, the NEJM published the Chinese study.

The 21-day treatment was named one of that year's major medical advances by several of the world's leading journals. It has also been written into the stroke treatment guidelines of many Western countries.

GLOBAL RECOGNITION

Wang remembers the day on which he shared the study with researchers from around the world at a conference in Hawaii. "I was in a bit of a trance as I stood on the stage. Is this true?" Wang recalled.

Before this turning point, Wang often found himself the only Chinese researcher among several hundreds of participants when attending international conferences.

"When foreign counterparts talked about large trials they had performed, it sounded like a fantastic tale to me," he said.

Wang decided to catch up in the field of clinical research on strokes. He kept an eye on cutting-edge international developments, and was not afraid to challenge conventional methods.

In 2019, Wang and his team found that the dual-antibody treatment did not work well on some patients who carry CYP2C19 gene mutations. An alternative drug might solve the problem, but how to identify the gene quickly? Conventional gene detection methods would take more than 10 hours, while stroke patients must be treated within 24 hours to prevent disability.

In 2020, Wang's team invented a rapid gene testing method that only targets the stroke-related gene and can shorten the detection time to less than 85 minutes.

Largely through Wang's efforts, the stroke recurrence rate was further lowered to 6 percent.

The study was published in June 2021 in the NEJM. This time, it was plain sailing. From submission to acceptance, it took nine days.

PROFESSIONAL EXCELLENCE

Wang studied at a medical college in Hebei Province in the 1980s, and graduated from Capital Medical University in 1989.

Some praised Wang's "quick brain" and recommended him to work in the Department of Neurology. From 1999 to 2000, he pursued postdoctoral studies at the University of Arkansas for Medical Sciences.

In 2000, he went back to China and was appointed vice president of the Beijing Tiantan Hospital, the country's top medical institution specializing in brain diseases.

Now 60 years old, he has been widely acclaimed for introducing technologies and personnel from abroad, and for promoting clinical research at the hospital, winning numerous awards. He made headlines in 2018 for organizing a human-AI competition on diagnosing brain tumors.

In 2020, Wang became the president of the hospital. Despite being extremely busy with administrative work, he spends one morning each week seeing patients.

In October this year, Wang was given the World Stroke Organization (WSO) President's Award, a prestigious prize in the field of clinical research on strokes.

At the award presentation, WSO president Marc Fisher said that Wang has made outstanding contributions to precision medicine research on strokes, particularly the reduction in stroke recurrence rates.

Rather than resting on his laurels, Wang has been conducting a third research project on CHANCE.

"My ultimate goal is to reduce stroke recurrence to zero," he said. "In my view, an excellent doctor can not only cure his own patients but is also able to propose therapies that can help patients worldwide."