Ismalia de Sousa: Keep up to date with the huge improvements in stroke treatment
Thrombectomy can transform people’s recovery after stroke but access to treatment still depends on a good understanding of symptoms and local care pathways.
Thrombectomy can transform people’s recovery after stroke but access to treatment still depends on a good understanding of symptoms and local care pathways
Brain imaging as a diagnostic tool for ischaemic or haemorrhagic stroke was developed in the 1960s, but more recently there has been an astonishing improvement in stroke care in the UK. While thrombolysis, the clot-busting treatment, is now considered to be usual care, a new kid on the block has emerged.
Thrombectomy, the mechanical removal of a blood clot by a guided wire, is the newest emergency stroke treatment. Its implementation across England is one of the biggest investments that NHS England specialised commissioning has ever made. The investment is a consequence of the analysis of five research trials of thrombectomy in acute ischaemic stroke patients published in 2016 by Goyal et al.
The first thrombectomy national data for England, Wales and Northern Ireland reported that 76.3% of patients improved after receiving the procedure.
Within five hours
Like thrombolysis, the inclusion criteria for thrombectomy means that not all stroke patients are eligible. They need to have a clinical diagnosis of ischaemic stroke, and it's essential that a clot in an artery of the brain is visible with brain imaging and easily accessible. The premorbid level of disability and co-morbidities, not related to age, also need to be taken into consideration as well as whether the risks will outweigh the benefits. The procedure should begin within five hours of symptom onset.
All nurses, irrespective of their area of practice, need to know how to recognise stroke symptoms (using mnemonics such as FAST: Face Arm Speech Time) and the pathways in their local hospitals to alert the stroke team.
It is imperative that stroke nurses and intervention neuroradiology nurses understand the thrombectomy procedure, and that possible complications are known, to allow for appropriate nursing care.
Goyal M et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet, 37, 10029, 1723-1Bra73.
Ismalia de Sousa is a clinical nurse specialist in stroke, Imperial College Healthcare NHS Trust