Thrombectomy: the new stroke treatment saving lives

Wednesday 26 October 2022

Let’s start with some facts! Ahead of World Stroke Day on 29 October 2022, it’s important to highlight the severe impact strokes have on people. Stroke is the fourth biggest killer in the UK, with 100,000 people having strokes each year – that’s one stroke every five minutes, causing 38,000 deaths annually. 

While the risk of having a stroke increases with age (they are more common in people aged over 55), anyone can be affected. To look after your loved ones, you should be aware of what happens when someone is having a stroke and the symptoms to look out for. Getting swift treatment at the hospital is crucial. Much in the same way as heart attacks, where timely treatment is urgent, strokes can often be described as ‘brain attacks’ and people need to be seen by a specialist as soon as possible.

Signs and symptoms of stroke

Due to the life-altering impact a stroke can have on a patient and their family, it is important to be aware of what a stroke is, how to recognise one and employ measures to lower risks for themselves and their families.

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications.

Signs and symptoms of stroke include trouble speaking and understanding what others are saying, paralysis or numbness of the face, arm or leg, problems seeing in one or both eyes, headaches and trouble walking.

Strokes are usually diagnosed by doing physical tests and studying images of the brain produced during a scan. National Institutes of Health Stroke Scale (NIHSS) is a systematic, quantitative assessment tool to measure stroke-related neurological deficit and is usually conducted by a neurologist or a stroke physician to diagnose the physical signs of stroke. A radiologist then helps confirming the diagnosis by performing a CT or MRI head scan. Large vessel occlusive stroke is diagnosed using a CT angiogram to identify the vessel occluded in the brain, along with a CT perfusion exam to check the viability of brain for treatment.

The main risk factors for stroke include high blood pressure; diabetes; high LDL cholesterol levels; and smoking. Other conditions that can cause blood clots or blockages, including coronary heart disease; atrial fibrillation; heart valve disease and carotid artery disease can also cause stroke.

Thrombectomy – a new lifesaving treatment

A thrombectomy is a relatively new lifesaving procedure for treating stroke. The Stroke Association recently published an open letter to the Government, calling on them to make this treatment available to all who need it.

Though it is one of the most effective medical interventions ever discovered, thrombectomy has only been available over the last few years. But even today, there is unequal access to thrombectomy, creating a postcode lottery. Unequal funding, insufficient levels of equipment, workforce shortages and barriers to training are just a few reasons why. We need stakeholders across hospitals and beyond, such as the ambulance service, stroke, imaging, and interventional units to work together for the procedure to work and to ensure more patients can access this treatment.

For the 10% of stroke patients (~7,510 patients in 2020/21) suitable for thrombectomy in England, this treatment can be life changing. It changes the course of recovery from stroke in an instant, significantly reducing the chance of disabilities like paralysis, visual impairment and communication difficulties. It is also extremely cost-effective. Rolling out thrombectomy fully could save the UK £73 million a year, by reducing demand for rehabilitation and community support services.  

During the procedure, a specialist doctor (an interventional radiologist) inserts a tube with a tiny wire cage into an artery near the groin. It is then guided up through the body and into the brain. Once in the right blood vessel, the cage captures the clot and removes it – immediately allowing blood to flow freely again. Removing the clot in the first go, or the ‘first-pass effect’, has been shown to lead to better outcomes for the patient. The patient can often be awake throughout the whole procedure, or it may be performed under general anaesthetic.

The procedure can also reduce the treatment to home time and increases the likelihood and extent of recovery in suitable patients. Some doctors call it close to a ‘miracle treatment’ because many patients can walk out of hospital the next day.

World Stroke Day 2022 is an important opportunity to highlight the importance of thrombectomy and its potential for drastically improving patient outcomes.

Dr Sanjeev Nayak
Consultant Interventional Neuroradiologist, University Hospitals of North Midlands NHS Trust

Dr Raghu Lakshminarayan
Consultant Vascular Radiologist, Hull University Teaching Hospitals NHS Trust

Dr Jai Patel
Chair of RCR Interventional Radiology Committee