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Too many stroke victims miss out on key procedure

12:00am | & News

When someone suffers a stroke, the treatment that follows can make a big difference to their future abilities and quality of life.

But now a National Stroke Audit backed by the Royal College of Physicians has found that around 9,000 stroke patients per year are missing out on a treatment which could prevent or limit future disability. Part of the problem is a lack of skilled staff able to carry out the ‘clot retrieval’ procedure.

It can restore blood flow to the brain and prevent some lasting damage resulting from a stroke, but according to the audit only around 600 patients per year currently receive this life-changing therapy.

During a stroke the blood flow to parts of the brain is interrupted, often by a blood clot blocking or partially blocking a major blood vessel in the head. The longer a part of the brain is deprived of blood, the more likely it is that there will be lasting damage, such as paralysis and speech problems.

Not all strokes are caused by a clot – some are due to a bleed ­– but in cases where a clot is the cause, early intervention to remove it can have lasting and significant benefits. At the moment most patients who suffer this type of stroke are given drugs designed to fragment and dissolve the clot, but this does not always work completely or quickly enough to restore healthy blood flow and prevent lasting damage.

Clot retrieval – or ‘thrombectomy’ – is a mechanical procedure designed to remove the clot. A thin metal wire housing a mesh is inserted into a major artery in the leg and guided under X-ray to the site of the clot in the brain. The mesh is then expanded, like a miniature fishing net, to capture and remove the clot.

Medical trials have shown that if it is carried out soon after a stroke caused by a clot, it can be highly effective in restoring blood flow to the affected parts of the brain and thereby limiting the damage.  However, it is a highly skilled operation which is currently only available at a few specialist stroke centres.

Researchers giving a presentation to the UK Stroke Forum estimated that one in 10 people admitted to hospital with a stroke could be eligible for a thrombectomy, which equates to around 9,000 patients per year currently not receiving the procedure. It has already been deemed safe and effective by medical watchdog body the National Institute of Health and Care Excellence (NICE).

Dr Martin James, from the Royal Devon and Exeter Hospital, said: “Delivering the procedure to the 9,000 people who need it will require major changes to the configuration and skill sets of acute stroke services.

“We must work quickly to establish what needs to be done so that more people in the UK can benefit from a treatment which can dramatically reduce disability after a stroke as well as cutting associated costs to the NHS and social care.”

NHS England said that stroke patients are receiving high quality care and plans are in hand to make the thrombectomy procedure more widely available across the country.

“We recognise the potential effectiveness mechanical thrombectomy could have for about 5% of stroke patients and are currently drawing up a policy for its possible use across the NHS,” said Professor Tony Rudd, national clinical director for stroke at NHS England. He added that stroke survival rates and standards of aftercare are now higher than ever before.

However, one of the biggest obstacles to rolling out the thrombectomy procedure across the country will be recruiting and retaining skilled staff able to carry it out. A spokesman for the Royal College of Physicians said: “There is a major shortage of appropriately trained staff to undertake thrombectomy, particularly outside of London, and it will take time to train up enough doctors to undertake this skilled procedure.”

• Acting quickly when a stroke hits can save lives and ensure a better chance of recovery. To recognise the symptoms of a stroke or mini-stroke, think ‘FAST’:

·         Facial weakness – can the person smile? Has their face dropped at one side?

·         Arm weakness – can the person raise both arms and keep them there?

·         Speech – Can the person speak clearly? Is their speech slurred?

·         Time – if you see any of these signs, it’s time to call 999. Stroke is always a medical emergency which requires immediate attention.

To watch Public Health England’s commercial for its ‘Act FAST’ stroke awareness campaign, click here.

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