To seize the opportunity for timely treatments, National Health Insurance Administration (hereinafter referred to as NHIA) has loosened the restrictions on performing mechanical thrombectomy for patients with acute ischaemic stroke (AIS) from November 1, 2023. The current indication is to “perform within 8 hours of an anterior circulation stroke onset.” However, taking into account that some patients are unable to go to a hospital on time due to being asleep, living alone, or residing in a rural area, as well as evidence and clinical guidelines worldwide, the indication is now extended to “within 24 hours of the onset.” The updated indication allows doctors to seize the golden window for cerebral reperfusion and improve patient prognosis. It is estimated to benefit an additional 565 patients per year and the budget is approximately 113 million points.

The Director General of NHIA Shih Chung-Liang said that the ischaemic stroke is currently the most common type of strokes in Taiwan and it is caused by an acute occlusion in cerebral blood vessels or a blood clot falling from the large vessel to cause cerebral embolism. Upon referencing international guidelines and empirical studies worldwide, the NHI restrictions on the time of performing thrombolytic agent injections and relevant treatments have been extended to 4.5 hours after the onset. However, in addition to administering thrombolytic agents, mechanical thrombectomy, which is using stent retrievers or aspiration catheters to remove blood clots, may also be adopted depending on the patient’s condition. Starting from 2016, the special materials required for said surgery haven been gradually added to the NHI package and the clinical physician are free to adopt the adequate device suitable for the patient’s condition. Currently, around 2,000 patients receive the surgery each year with approximately 270 million points paid from the NHI special material payment.

The president of Taiwan Stroke Society Lian Li-Ming stated that receiving timely and adequate treatments reduces the risks of sequelae such as moderate or severe disabilities for patients suffering an AIS onset. Therefore, NHIA is proactively making adjustments to payment regulations via constant reviews to stay in line with international guidelines and ensure timely treatments for patients with a stroke onset. Moreover, it is expected to minimize the impact of the onset on the patients’ livelihood and quality of life with an improved prognosis and reduced level of disability. The updated regulations shall maximize the effectiveness of NHI benefits and give more options to the clinical physicians.