STROKE is a devastating condition. About 40 per per cent of patients with stroke will have a blockage in one of the large vessels in the brain and this group have the worst outcomes.
Up until a number of years ago, even with best medical treatment, including clot busting drugs, three quarters of these patients would either not survive or have to live with significant disability.
In recent years, a group of highly specialised doctors have developed a technique known as thrombectomy which involves physically removing the clot from the blocked artery in patients with acute stroke.
The team in Belfast have developed expertise in this technique and have taken part in one of the international research studies looking at this.
Over the last three years, the Royal, which is now one of the leading centres in the UK, have used thrombectomy to treat about 150 patients with stroke due to a blockage in one of the large vessels in the brain. This includes patients admitted directly and some transferred from other hospitals, and the results are dramatic.
The number of patients with a good outcome after thrombectomy is approximately double what we would expect with normal treatment. To see patients and their families being rescued from the devastating effects of a major stroke is one of the most gratifying things I have experienced in over 25 years as a doctor. The development of this treatment in Belfast is largely due to the commitment and dedication of all of the specialists involved.
The service is currently available at the Royal to all suitable patients across Northern Ireland within working hours and we are keen to work with the wider health service to develop a full 24/7 service. However, this is only part of the equation. If patients arrive too late, then we often find that the brain is irreversibly damaged, and we know that performing a thrombectomy is unlikely to help. It is therefore important that patients needing clot thrombectomy get to us as quickly as possible.
To facilitate this, we need to organise stroke services in such a way to give patients with acute stroke the best possible chance wherever they are in Northern Ireland. This may mean that some patients will go to a local stroke centre first to get rapid assessment and clot busting therapy, with transfer to Belfast if appropriate. Other patients will go directly to the Royal.
It will be essential that local stroke centres have the specialist staff and facilities to provide rapid brain imaging and treatment on a 24/7 basis so that there are no delays identifying and transferring those patients who require thrombectomy.
If there are delays, then fewer patients will be eligible for treatment and the outcomes will not be as good. For some patients, getting the best treatment as quickly as possible,may mean bypassing their nearest hospital.
The current organisation of stroke services in Northern Ireland has served us well for several years and allowed introduction of new treatments such as clot busting therapy. However, having seen first-hand the life changing benefits of thrombectomy for patients with the most severe type of stroke, I strongly support the need to review the current configuration, to ensure that there is rapid specialist assessment and treatment at every step of the emergency pathway.This may mean providing services on a fewer number of sites, but ultimately all of these changeswill improve outcomes and reduce disability after stroke."
*Dr Ivan Wiggam is the clinical lead for stroke services in the Belfast Health and Social Care Trust
