Analysis

Stroke patients set to receive new treatment

A new technique to remove blood clots from arteries could soon be integrated into everyday practice to treat patients with ischaemic stroke

A new technique to remove blood clots from arteries could soon be integrated into everyday practice to treat patients with ischaemic stroke.

The treatment, thrombectomy, allows specialists to use a wire to pull out a clot from a blocked artery, and thereby restore blood flow as soon as possible.

Local and international stroke care experts are seeking new ways of delivering this treatment alongside more conventional techniques, such as thrombolysis in hospitals across the country.

Routine practice

At a conference on hyper-acute stroke care hosted by the University of Central Lancashire (UCLan) in September, the biggest concern voiced by healthcare professionals was how to introduce the new treatment into routine practice.

Early discussions concerned the possibility of undertaking thrombectomy at specialist centres after patients have received thrombolysis at their local hospitals.

More delicate

Practitioners trained in thrombectomy must understand cerebral circulation and know that the blood vessels in the brain are more delicate than elsewhere in the body.

The process may have to be done in two stages; first in a local hospital, then at a specialist centre, which has financial and time delay implications.

UCLan professor of stroke and older people’s care Caroline Watkins says: ‘The new treatment has huge implications for the way we treat stroke patients but of course it presents practical challenges such as identifying which patients need the treatment and who the experts to deliver this high-quality care would be.

Technically challenging

‘Thombectomy is technically challenging: it requires training, practice and then frequent delivery to maintain staff skills,’ Professor Watkins adds. ‘We need to decide whether it’s the stroke doctor, neuroradiologist or even a cardiologist.’

Recent advances in thrombectomy and its potential to reduce morbidity and the often devastating disability associated with stroke highlight the importance for nurses and healthcare professionals to keep up to date with emerging evidence.

UCLan senior lecturer in emergency and unscheduled care Lorna McInulty says: ‘We need to be mindful that it is not just hospital staff who need to be aware of these developments, but also staff in pre-hospital care. We need to include this important professional group in the rolling out and development of stroke pathways,’ Ms McInulty adds, ‘Particularly where patient transfers are involved.’

Worldwide study

As the new treatment is set to be rolled out to hospitals, a worldwide study examining the best nursing methods for different types of stroke is also due to start.

HeadPost, led in the UK by Professor Watkins, will research whether stroke patients should be laid down or sat up when admitted to hospital. 20,000 participants from six countries will take part, with 5,000 from the UK.

According to Professor Watkins, there is ‘no good evidence’ for using either position. ‘The way nurses position patients following stroke varies between countries. Most patients are placed upright in the UK and Australia, but in China and India they are reclined. In the United States and Switzerland, position is based on the type of stroke. None of this is evidence based. Whenever there is uncertainty, we need a trial.’

Upright or lying flat

During the research, stroke units will be randomly allocated one of the upright or lying-flat positions and will then change over to the opposite position after a defined period. All patients who are admitted with symptoms of stroke will be monitored by nurses in these positions.

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. Researchers will conduct follow-up interviews with patients after 90 days.

Professor Watkins says: ‘There is currently no evidence for what nurses are doing now. HeadPost will hopefully give us the best nursing methods for different types of stroke and ultimately lead to improved care for stroke patients. It’s great to be able to offer patients in the UK the opportunity to take part and ultimately it means we can save more lives.’

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