A pioneering new way to remove blood clots from blocked arteries could soon become part of everyday medical practice.
The treatment, known as thrombectomy, allows a special wire to pull out a clot from a blocked artery to restore blood flow as soon as possible. It works alongside another established treatment called intravenous thrombolysis; a specialist clot-busting drug that can be given to patients to break down blood clots. Together the treatments have the potential to limit the damage caused to stroke victims.
Now local, national and international stroke care experts are working to find new ways of delivering the additional new treatment, which is yet to be introduced into routine clinical practice with the exception of a few specialist centres, in hospitals across the country.
Stroke is the third leading cause of death in England and the leading cause of disability. More than 150,000 people have a stroke every year in the UK but, according to The Stroke Association, up to 10,000 of these could be prevented if more people were aware of the symptoms and sought out emergency treatment.
At a conference on hyper-acute stroke care hosted by the University of Central Lancashire (UCLan), in partnership with the All India Institute of Medical Sciences (AIMS), UCLan Professor of Stroke and Older People’s Care Caroline Watkins commented: “This innovative new treatment has massive implications for the way we treat stroke patients but of course it presents practical challenges such as identifying which patients need the treatment and potentially having to transfer them to a different hospital that has a physician who can deliver the treatment.
Professor Martin Dennis from the Centre for Clinical Brain Sciences in the Stroke Research Group at the University of Edinburgh commented: “These are exciting times for stroke care.
Early discussions suggest the new treatment will need to be delivered at specialist centres following a thrombolysis which can be given at the patient’s local hospital. Practitioners trained in thrombectomy will need to have an understanding of cerebral circulation (the way that blood flows through the brain), and an appreciation that the blood vessels in the brain are much more delicate than elsewhere in the body. It is also important to recognise that because the process may have to be done in two stages; in hospital then at a specialist centre, this has implications both in time delay and also financially.
Plans to roll out the new treatment method come as a worldwide study into the best nursing methods for different types of stroke gets underway with 20,000 participants from six countries taking part; 5,000 of these will be from the UK.
HeadPost, led in the UK by Professor Caroline Watkins, is examining the best nursing methods for different types of stroke. The work includes vital research on whether stroke patients should be laid down or sat up when admitted to hospital.
During the research stroke units will be randomly allocated one of the positions – upright or lying flat first, and will then changeover to the opposite position after a defined period. All patients who are admitted with symptoms of stroke will be monitored by nurses in that position.
Nurses will carry out neurological assessments of the patients on admission, maintaining positions, every hour for the first 24 hours and again after seven days or on discharge, whichever is sooner. Researchers will conduct follow-up interviews with patients after 90 days.
Professor Watkins added: “What nurses have to understand is there is no evidence for what they are doing now. Some things we do because it is custom and practice.
The UK contribution to the global research will be centred in the Lancashire Clinical Trials Unit (CTU), a facility directed by Professor Watkins. The unit is the first of its kind in Lancashire and will primarily focus on supporting complex intervention trials in stroke, midwifery, cancer, musculoskeletal health, public/population health and mental health.