‘I had surgery on Sunday and was home by Monday’: calls for NHS rollout of gamechanging stroke treatment

In January this year, Deb Kelly, a prison officer and physical education instructor, collapsed in her home with a stroke. Kelly, 53, a dedicated runner, was at risk of permanent paralysis or even death. Her speech was slurred, her face drooped, and she had lost significant movement on her left side.

Her family called an ambulance and she was taken to Royal Stoke University hospital, where she received a treatment called mechanical thrombectomy to remove the blood clot in her brain that had caused the stroke.

A few days later she was fired; her speech was restored and movement on her left side was restored. “I walked out of the hospital, which is incredible, because I knew what could have happened if I hadn’t been treated quickly enough.” Doctors told her that without treatment she would likely have died or been left in a minimally conscious state.

Most strokes are caused by blood clots, and mechanical thrombectomy is appropriate if the blockage is in a larger artery. In this procedure, a wire and tube are inserted into an artery in the groin and maneuvered toward the brain to pull out the clot.

There are now 24 centers in England offering the service, 10 of which provide 24-hour access to the treatment, including units in London, Bristol, Birmingham and Greater Manchester, according to a study carried out by the UK Neurointerventional Group (UKNG), a body representing specialist doctors with expertise in mechanical thrombectomy and affiliated with the Royal College of Radiologists (RCR).

The number of procedures in England rose from 1,490 in 2019-2020 to 2,684 in 2022-2023, an increase of 80%.

It’s a dramatic increase in access compared to seven years ago, when the treatment was first championed by a small group of advisers, but experts are calling for a faster rollout to save more lives and prevent permanent disability.

Dr. Hannah Stockley, honorary secretary of the UKNG and consultant at Salford Royal Hospital in Greater Manchester, said: “Despite the pandemic, we have managed to expand services and aim to bring this service to more people.”

Stockley said more investment was needed from NHS England. At least 10% of stroke patients are eligible for a thrombectomy in England, but only 3.3% receive it, according to the charity the Stroke Associationbased on data from the Sentinel National Stroke Audit Program.

Doctors, patients and the Stroke Association say there are wide disparities in accessing treatment across the country. In London, around 9.8% of stroke patients benefit from treatment, compared to 0.4% in the east of England.

The NHS long-term plan published in January 2019 aimed to achieve a tenfold increase in the number of stroke patients undergoing mechanical thrombectomy by 2022, but missed this target. There are more than 100,000 strokes in Britain every year.

Dr. Sanjeev Nayak, a neuroradiologist who set up the first 24-hour mechanical thrombectomy service at Royal Stoke University Hospital, said: “There are still thousands of patients missing out on this treatment. They could walk out of the hospital disabled or dead because they don’t have access to this life-saving procedure.”

Peter Hooper, 63, who suffered a stroke in June 2020 and was treated by Nayak, is among those calling for better access. “Within two or three hours of my stroke, I was in the theater with Sanjeev and his team,” Hooper said.

“I had the thrombectomy on Sunday morning, the physio team was working on me on Monday morning and I walked out of the hospital on Monday afternoon. It was unbelievable, but it is a postcode lottery.” Hooper, who would have been severely disabled without the treatment, has since run two half-marathons, raising money for the Stroke Association.

Dr. John Stephens, 60, a GP who lives near Blandford in Dorset, suffered a stroke in September 2021 and had a thrombectomy at Southampton General Hospital. He said that within six months he could be sailing and hiking in the Alps. He said: “You wouldn’t have expected this kind of recovery in the past.”

Stephens said he was fortunate to benefit from the treatment and wanted to promote wider access. He said there is work to ensure more doctors can provide the service, including a new professional qualification sponsored by the RCR for doctors from non-radiology specialties to carry out the procedure, but that more investment also needs to be made in the rehabilitation of patients after treatment.

The Stroke Association says it welcomes the work of thrombectomy teams who have “worked tirelessly” to improve access, but says it should be a “rallying cry” for a wider rollout of 24-hour services. Juliet Bouverie, chief executive of the Stroke Association, said: “Thrombectomy is a miracle treatment that transforms recovery, significantly reducing the risk of disabilities such as paralysis, visual impairment and communication problems.

“It is unacceptable that whether you can have a thrombectomy still depends on where you live and when you have your stroke. Rapid access to thrombectomy should be available to all stroke patients who can benefit from it, so that more people have the best possible chance of recovery.”

National Clinical Director for Stroke at NHS England, Dr Deborah Lowe, said: “Mechanical thrombectomy is a ground-breaking treatment for stroke patients, which can dramatically improve outcomes and reduce disability, and the NHS remains on track to achieve a to achieve a tenfold increase in the delivery of this treatment. for eligible patients, with more than a third of thrombectomy centers currently offering 24/7 services and all others actively working to provide this level of access across England.

“The NHS is also taking further steps to ensure people are treated quickly for stroke, including deploying AI tools to support the real-time interpretation of brain scans and video triage linking ambulance teams with stroke specialists to enable rapid and informed decision-making guide and enable more patients to get the right treatment, in the right place, at the right time.”