The first step towards a national thrombectomy service for stroke patients is underway with the launch of a pilot in the North of Scotland.
Thrombectomy is a highly skilled procedure in which blood clots are removed mechanically rather than broken down by medicines (thrombolysis). It is used to treat those with severe stroke and reduce their risk of long-term disability.
NHS Tayside developed a training programme in Mechanical Thrombectomy (MT), supported by the Scottish Government. Key staff were trained by Professor Iris Grunwald, one of the UK’s leading stroke thrombectomy interventional neuroradiologists, using advanced simulation techniques.
Initially the thrombectomy procedures in Dundee will be performed on patients in Tayside before the service is extended to patients across the North.
A fully operational 24/7 service is anticipated in Tayside by 2023, and will form part of a national network in line with the Scottish Government’s Programme for Government commitment.
In the West of Scotland, the Queen Elizabeth University Hospital campus will provide a ‘hub’ thrombectomy service for the West of Scotland by 2023, while the NHS Lothian service will also be operating from the Little France site within the same timeframe.
Health Secretary Jeane Freeman said: “Over the past 10 years, the number of people dying from stroke in Scotland has decreased by more than 35%. While this is significant progress, we can still achieve even better outcomes.
“A quality and clinically safe thrombectomy service is part of our wider commitment in this year’s Programme for Government to ensure those who experience severe stroke receive the best possible treatment and care.
“It is testament to our healthcare professions that we are now seeing this first step towards a national roll-out, despite the additional pressures placed on them during the pandemic and I want to thank them for their hard work.
“Funding will continue to be made available to other boards to develop the programme and the framework.”
Honorary consultant interventional radiologist in NHS Tayside Professor Graeme Houston said: “We are delighted to be able to launch this service to provide mechanical thrombectomy for patients in the North of Scotland.
“Thrombectomy delivers a significant benefit for some patients who have sudden onset of stroke with significantly improved outcomes and a reduced level of disability.”
Chest Heart & Stroke Scotland Chief Executive Jane-Claire Judson said: “It’s good that we are seeing tangible progress towards thrombectomies being available to stroke patients in Scotland.
“People in Scotland must be given the best possible chance of living without disability or dependency after a stroke. We know that at least 600 people a year in Scotland would benefit from a thrombectomy. Developing the skills to deliver this procedure is a key part of establishing the service in Scotland.
“This progress is being driven by inspirational stroke survivors campaigning for change. Together, we will keep campaigning to make sure that this game-changing stroke treatment is available as soon as possible.”
The Stroke Association in Scotland welcomes the announcement that mechanical thrombectomy is to be made available to some Scots for the first time since 2018.
This is a long overdue but a significant first step towards delivery of a national thrombectomy service for the whole of Scotland which should be in place by 2023.
Thrombectomy is vital. Around 700 stroke patients are eligible for the procedure in Scotland each year. Patients who have a stroke caused by a large blood clot in the brain would potentially benefit from a thrombectomy procedure.
It involves inserting a catheter into an artery, usually within six hours of someone having their stroke, to remove the blood clot. This allows blood flow to resume and oxygen to reach brain tissue.
The treatment can dramatically reduce the devastating consequences of stroke such as losing the ability to walk and talk. Around one in three people who receive a thrombectomy after their stroke will be less disabled as a result, and around one in five of those who receive it will be able to function completely independently afterwards.
Andrea Cail, Director Scotland for the Stroke Association said: “Thrombectomy is a game-changing treatment, and it is good to finally have it available in Scotland again. But it is only the first step. Stroke is now a clinical priority in Scotland and restarting a thrombectomy service for those need it will be the difference between living or dying; living permanently disabled or without any disabilities at all.
“Thrombectomy is an extraordinary, highly-specialised, procedure that can save lives, reduce disability and is absolutely cost effective. One thrombectomy patient is estimated to save the NHS £47,000 over a five year period.
“We congratulate everyone involved in the North of Scotland thrombectomy planning group on making this happen. We know it’s not been easy. It has required serious commitment from everyone involved. By working together, hundreds of people affected by stroke and their families will benefit over the next few years.
“All Scots deserve the same. Thrombectomy must also be made available to the larger population centres of Glasgow and Edinburgh as soon as possible.
“We urge all those involved in developments for these next two sites to work together with purpose, and for the Scottish Government and Health Boards involved to urgently resolve or remove any barriers towards implementation and delivery. The time it has taken and is taking Health Boards to sort this out is lengthy and unacceptable.”
Professor Rustam Al-Shahi Salman, consultant neurologist in Edinburgh and President of the British Association of Stroke Physicians, says: “Mechanical thrombectomy for acute ischaemic stroke is one of the most effective treatments in modern medicine.
“We knew this in 2015. In the last five years, about 45 people in Scotland have had this treatment, but about 700 people should have it each year. I am relieved that this dire disservice to patients with stroke is beginning to come to an end in Tayside. Patients elsewhere in Scotland deserve the same.”
Case study
Norrie Andrews, 77, from Glasgow had his stroke in Majorca last year. Only a few days into the holiday, Anne, Norrie’s partner, had gone to check on some electricity issues they had been experiencing. On her return, she found Norrie slumped over the side of his chair unable to talk and unable to move. Norrie had had a massive stroke.
He was taken to the local hospital quickly, and was administered with thrombolysis, a drug to break up the clot. Unfortunately the thrombolysis had no effect and the doctors decided Norrie would benefit from thrombectomy. He was immediately transferred to Son Espases University Hospital in Palma.
Anne had to give consent for Norrie to undergo thrombectomy (on his behalf.) It felt like an endless series of questions and forms that needed answered.
The procedure took 15 minutes and when Anne went up to the intensive care unit to see him she was amazed. He was alert, his speech was starting to come back and some movement too. They could hardly believe how something so horrifying had turned on its head.
Norrie still had some mild impairments, but the seriousness of his disability was saved (they believe,) by thrombectomy. And just over two weeks later, Norrie walked out of hospital without any difficulty and his speech was fine.
Anne said: “The doctors told me that had Norrie not had thrombectomy, he would never have been out of a wheelchair or spoken again. I was so relieved to hear this and we both felt very fortunate to have been in Majorca at the time.
“After returning home, I discovered thrombectomy would not have been available at the time of Norrie’s stroke. I was amazed to think a small island like Majorca had the treatment my husband so badly needed. Norrie is now back to his old life again.
“He walks every day and I am thrilled he has started to play golf again. He keeps his brain ticking over with puzzles, crosswords and word searches. He’s seeing his friends now, which has lifted his spirits and I’m able to see my own friends too.
“I am thrilled to hear thrombectomy is available in Scotland now. Stroke is a devastating illness and the disability caused by a stroke can be lifelong, destroying lives. I hope now there will be more people in Scotland making better recoveries from stroke because of thrombectomy.”