Achieving the best care for stroke sufferers
Cardiology Dr John Thornton, Consultant Interventional Neuroradiologist and Clinical Lead for Strokes in Beaumont Hospital Dublin, highlights the benefits of mechanical thrombectomy.
“Mechanical thrombectomy is a treatment used to remove a large blood clot from inside a blood vessel in a patient’s brain,” explains Dr John Thornton. “Before this was developed, Irish patients were receiving clot-busting drugs to help dissolve the clot instead of pulling the clot out but what became evident was that these drugs didn’t work as well when there was a large blockage in the brain. Thrombectomy provides the greatest chance of patient recovery from large blockages which cause the most devastating strokes.”
While stroke symptoms include sudden numbness or weakness in the face, arm or leg, possibly with loss of speech, Thornton explains underlying causes such as atrial fibrillation, an irregular heartbeat which increases the risk of an acute stroke, may not have symptoms.
“Local GPs should monitor the heart rate of their patients frequently. This way they can identify and treat atrial fibrillation before it causes a stroke"
“If a patient does experience the symptoms of a stroke, it is vital to receive appropriate clinical assessment and scanning in hospital early to confirm it is a blockage of a blood vessel. Patients are then referred to our interventional lab in Beaumont Hospital, the main route to thrombectomy. We will do an endovascular procedure, puncturing the artery and groin to pass a tube in the blood vessels up to the neck and head. Through the tube, we place a stent retriever, which pulls the blood clot out, restoring blood flow to the brain tissue.
“Beaumont participated in a trial called ESCAPE to show the benefit of the procedure for acute stroke victims. After the treatment 53 per cent of patients had a fully independent life with no disability. Of those who received best medical management without thrombectomy, only 29 per cent achieved an independent life afterwards. Also the risk of dying from the stroke was halved. This is a dramatic change in outcome and for the individual patients, a truly life transforming procedure.
“Three years ago we treated approximately 53 patients, approximately 46 the year after and last year we treated about 123 patients. It’s increasing rapidly and we feel that up to 500 patients or more per year should potentially be receiving this treatment in the future.”
Of course, figures can continue to significantly increase if all medical personnel and patients are fully aware of the benefits of the treatment, and with appropriate investment into Beaumont Hospital and Cork University Hospital to grow the service.
“We are currently negotiating funding with the HSE, to further develop the service so that it’s rapidly available to everybody,” says Thornton. “We began the service without any additional funding or new structures in place. There are charities such as the Irish Heart Foundation that are currently in the process of reviewing guidelines to publish a formal protocol for patients and doctors on how to approach and deal with a large-vessel stroke. But we need the HSE to formally recognise the importance of medical thrombectomy and to support urgent development of the service because it is essential that stroke patients in Ireland are getting the best standard of care possible.”