When stroke strikes, part of your brain shuts down, and so does a part of you. The race to give the best medical treatment starts from the moment 999 is called. Paramedics will take you to the most appropriate hospital, you might have a brain scan, and then the rush will be on to find the best treatment.
The chances are – as in 80 per cent of cases – you will have a blood clot that is blocking the blood flow in your brain. This is called an ischaemic stroke, and every minute 1.9 million neurons and seven miles of axonal fibres die.
Parts of your brain begin to die. This is why stroke is the leading cause of adult disability. If the clot is big enough, this could be fatal. Until recently, clots were only treated with thrombolysis, medication that dissolves the clot and improves blood flow.
The good news is that for 10 per cent of patients with a large clot, there is now a new miracle treatment. The bad news is that currently less than 20 per cent of those eligible will receive it.
This innovation is thrombectomy, a truly remarkable procedure where a flexible tube with a tiny wire mesh stent – or cage – on the end is inserted into an artery near the patient’s groin and carefully guided up through the body into the brain. The cage then closes around the clot, which is plucked out, allowing blood to flow freely again, immediately.
More than 10,000 stroke patients a year in the UK could benefit from this game-changing procedure, and for these patients it can mean the difference between death (or a life of severe disability) and walking independently out of hospital in a few days.
Specialists called interventional neuroradiologists must carry out the procedure. In many areas, services are not joined up across hospitals to share doctors, equipment and expertise. Your chances of receiving this treatment vary depending on where you live, how quickly you got to hospital, and even what time of the day or week you have your stroke.
Even when services have the right staff and equipment in place, pressures on other parts of the system, such as the availability of ambulances, can have a knock-on effect, preventing you from being transferred to the most appropriate hospital. Each procedure saves someone from the most severe disability or in some cases death. Investment made now will also save the NHS £47,000 per patient.
The estimated cost of fully implementing thrombectomy across the UK would be around £400m, but would save £1.3bn in ongoing care and support costs. To realise these benefits requires urgent action. Every thrombectomy missed is a costly opportunity wasted for a better life.
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There is no hiding from the fact that there are significant challenges to delivering thrombectomy in many parts of the UK. Despite the great job our NHS workforce is doing, we simply do not have enough trained specialists. This limits the availability of this service greatly and means that as many as 8,400 stroke survivors could be missing out every year. The quicker we can sort the stroke workforce problem, the quicker we can save lives, and then the health service can better divert money to stroke support and prevention.
In 2019, the NHS made a rightly ambitious commitment to increase the number of annual thrombectomies tenfold by 2022, placing it at the centre of its ambitions for stroke care across the next decade. In Northern Ireland, plans were put in place to expand thrombectomy services in Belfast, while Wales developed arrangements with stroke specialists in Bristol in order to expand provision.
The number of thrombectomies carried out started to grow. However, since then we have hit a number of roadblocks, which paint a bleak picture for a game-changing service that needs to be available to everybody it would benefit.
Disappointingly, these hurdles mean that the NHS in England is unlikely to hit its Long Term Plan targets, with only 1,600 patients – or 1.8 per cent – having received the treatment in the last financial year, reaching a projected 3.2 per cent by 2025, compared to the target of 10 per cent. It is clear that we still have a very long way to go to give all eligible patients the treatment they need.
Without thrombectomy, if you have a stroke, you are more likely to be dependent on your family for your daily needs. You could require care and support for the rest of your life. Stroke turns people’s lives upside down in an instant, leaving stroke survivors to face challenges such as physical disability, trouble with communication, and changes to their emotional and mental health.
Two-thirds of all stroke survivors leave hospital with a disability. Each and every patient who is not offered a thrombectomy is being subjected to system failure and, given the huge difference it can make, this cannot be allowed.
While we know that national developments have been delayed as a result of the Covid-19 pandemic, it is now more important than ever that thrombectomy ambitions are delivered to both improve stroke patients’ quality of life and reduce the ongoing impact on the NHS at a time when it is under a huge amount of pressure.
We need to see increased capital funding to support existing thrombectomy centres and establish new ones. We need to see a pragmatic approach to training and workforce development that is prioritised by key bodies such as the General Medical Council, Royal College of Radiologists, and Health Education England. And we need to see the successful adoption of the best practice pathways, data and frameworks developed by the national Thrombectomy Implementation Group at a local level.
We won’t see the benefits of this treatment unless we continue to work together at national, regional and local levels to deliver them. If not, we will continue to fail those stroke survivors who have the most to gain, while needlessly placing additional burdens on the health and care system. Action is needed – now.
Juliet Bouverie OBE is chief executive of the Stroke Association.
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