Thousands of stroke patients will be saved from lifelong disability after NHS England decided to invest millions of pounds in a new treatment hailed as a 'game changer', reports The Guardian.
About 8,000 people a year who have a stroke will benefit from a massive expansion in the number of hospitals offering mechanical thrombectomy.
Currently only a few hundred patients a year receive the treatment and just a handful of hospitals in England offer it, despite its proved effectiveness.
Stroke experts say the procedure can produce remarkable results, with patients who would otherwise have ended up in a wheelchair instead able to walk out of hospital within 48 hours of having it.
“Thrombectomy is a real gamechanger which can save lives and reduce the chances of someone being severely disabled after a stroke,” said Juliet Bouverie, the chief executive of the Stroke Association.
“This decision by NHS England could give thousands of critically ill stroke patients an increased chance of making a better recovery. It could also mean more stroke survivors living independently in their own homes, returning to work and taking control of their lives again as a result,” she added.
A thrombectomy is used to remove a blood clot in someone’s brain which has not dissolved despite the patient receiving clot-busting thrombolytic drugs.
It involves a doctor putting a thin tube into a patient’s artery, usually through their groin, and then feeding it up through their body to where the clot is in their brain. Once there, a wire mesh tube called a stent – usually used in heart or vascular surgery – on the top of the tube is wrapped around the clot and it is then pulled out by a doctor called an interventional neuroradiologist.
Doing that restores normal blood flow to the brain and greatly reduces damage to brain tissue, which is what causes patients to suffer long-term, often serious damage to their physical and mental functions. Patients are either sedated or under general anaesthetic during the procedure, which must be carried out within six hours of the stroke occurring
“This major national upgrade to stroke services puts the NHS at the leading edge of stroke care internationally,” said Simon Stevens, NHS England’s chief executive. “It’s another practical example of the NHS quietly expanding innovative modern care that will really benefit patients, but which tends to be invisible in the public debate about the NHS.”
Stevens is keen that the NHS follows the lead of Germany and France, which undertake 7,500 and 3,500 thrombectomies a year respectively. While the procedure can help 10% of the 90,000 people a year in the UK who are admitted to hospital following a stroke, fewer than 600 patients a year in England have one.
Although the procedure costs about £12,000 to perform, the big savings in medical and social care for patients who would otherwise have been left seriously disabled have convinced NHS England that it represents value for money.
St George's in London is the only hospital in the UK to offer thrombectomy around the clock every day of the week. NHS England hope the massive expansion will lead to 24 NHS trusts which are centres of excellence in neuroscience operating on the same 24/7 basis as the NHS becomes more of a seven-day service.
Dr Jeremy Madigan, a consultant diagnostic and interventional neuroradiologist at St George’s, said: “Our patients are benefiting from the thrombectomy service we provide, with an 80-90% chance of opening up blocked vessels via this technique, compared to 30% with traditional clot-busting drugs.
“Providing a thrombectomy service at all times of day, as we do at St George’s, radically improves the range and mix of interventions available to us as clinicians.”
However, Bouverie said that creating 24 centres to perform the procedure would compel the NHS to centralise acute stroke services in fewer places, which would likely prove controversial.
It would also require a big increase in the number of interventional neuroradiologists the NHS employs – currently about 90 – especially if the service is to operate around the clock.
[link url="https://www.theguardian.com/society/2017/apr/11/nhs-england-stroke-treatment-mechanical-thrombectomy"]The Guardian article[/link]