Surprising MUSC connection to Uruguay's move to cover more costs of stroke care

Alejandro Spiotta, M.D., and Roberto Crosa, M.D., had no idea when they met that it was the beginning of a friendship that would help improve health care in Uruguay.

Spiotta is a neurosurgeon at MUSC Health, a professor of Neurosurgery and Neuroendovascular Surgery at the Medical University of South Carolina, vice chair of Neurosurgery and chief of Neuroendovascular Surgery. It’s a long list, and it has an informal new addition: expert advisor on stroke care in Uruguay.

Crosa is also a neurosurgeon, an adjunct professor at MUSC and chief of Endovascular Surgery at Medica Uruguaya. He, too, has a new addition to his resume: the Uruguayan doctor who helped convince his country’s leaders to ensure people have access to neuroendovascular treatments for stroke, aneurysms and arteriovenous formations, also known as AVMs. The treatments are minimally invasive solutions to potentially life-threatening problems that can lead to strokes if left untreated.

 

Crosa credits his relationship with Spiotta and his team for helping to bring about the change. “MUSC has been an indispensable international reference in the evolution of endovascular treatments in Uruguay.”

Understanding how an academic medical center in Charleston, South Carolina, came to play a role in health care in South America requires knowing a story that began in 2015. That’s when Spiotta and Crosa attended a conference in Uruguay. Spiotta’s flight was delayed, and he arrived around 11 p.m. He, Crosa and some other physicians went out for a late dinner. While they were waiting for dessert, Crosa got a call about a patient who needed his help. 

“My ears perked up. I said, 'What's going on?'” Spiotta remembered.

“When I realized that he was going to help this stroke patient, I'm like, ‘I'm going in. There's no way I'm going to miss seeing this.’ Because we always like to learn from each other.”

That’s how the Charleston doctor found himself in a hospital in Montevideo after midnight, watching what turned out to be a complex case. Spiotta ended up getting involved in figuring out how to open a stubbornly blocked artery. “Together, we came up with a technique that had never been done before, which is just spur of the moment. And we did it.”  It was later published as a novel technique in the Journal of Neurosurgery.

That collaboration was the beginning of a bond that had both doctors traveling back and forth to each other’s countries to visit and learn. They worked on stroke research together, publishing a book on ischemic stroke management. They gathered information for the Stroke Thrombectomy and Aneurysm Registry, or STAR. And when Crosa told Spiotta how some people weren’t getting the aneurysm and AVM treatments they needed in Uruguay, the South Carolina neurosurgeon knew MUSC needed to help.

Crosa explained the problem this way. “In Uruguay, until now, neurological endovascular treatments for aneurysms and AVMs could only be received in two ways. 1. Making a plea to the Ministry of Health. 2. Paying if you had enough money.”

Spiotta and MUSC helped bolster Crosa’s push to change that. “Roberto's been working on this for the 10 years that I've known him. And things that we've done to help him is I've written affirmations saying he's an expert. He works with us,” Spiotta said.

Like Crosa, Spiotta believes Crosa’s connection with MUSC made all the difference. “To go to the government as a Uruguayan who's concerned is one thing, but to do that as an expert who also has an appointment at a major university in one of the leading stroke treatment centers in the world –  that gave him so much. And that's the part I didn't appreciate at the time.”

Spiotta does now, after giving his own testimony to government officials about the need to give more people access to endovascular treatments and supporting Crosa. The Uruguayan neurosurgeon was determined to succeed. “This has been going on for many years; it was an unfair situation. Personally I have developed the protocols, but I have also fought to convince the political system of this urgent need,” Crosa said.

Last week, he and other health care experts finally did. On Jan. 27, Karina Rando, Uruguay’s minister of Public Health, announced that hemorrhagic strokes are covered by the National Resource Fund free of charge for everyone. It covers the treatment and both aneurysms and acute AVMs.

Crosa was thrilled. “Uruguay needed universal coverage of this type of treatment,” he said.

Spiotta was pleased that MUSC could play a role. “Through him learning from us and us from him, improving techniques that allowed him to help the patients he's treating on the table, is great. But through this bigger initiative, now he is helping everybody in Uruguay and even in the future. So that just made it a thousand times more powerful.”