The benefits of mechanical thrombectomy
Stroke Clot-busting surgery can save thousands of lives - and thousands of pounds spent on stroke care.
Using surgery rather than drugs to remove blood clots that cause stroke has the potential to restore a patient’s quality of life – and save thousands in health and social care costs, believes Dr Tufail Patankar, a consultant interventional neuroradiologist at Leeds General Infirmary. So, why do only a few hundred patients in England benefit from this procedure, he asks?
The procedure, known as mechanical thrombectomy, is used when the patient suffers an ischaemic stroke, or a stroke caused by a blocked artery. Ischaemic strokes are by far the most common type of stroke, accounting for almost 85% of all strokes. During a mechanical thrombectomy the surgeon uses specialist equipment to reach inside the blocked artery, and physically remove the clot – “a bit like unblocking a drain”, explains Dr Patankar.
Even though the procedure is still relatively new, mechanical thrombectomy is already considered a breakthrough. Compared to the previous ‘gold standard’ ischaemic stroke therapy of clot-busting drugs, mechanical thrombectomy gives the patient a longer ‘window’ in which to receive treatment and it also offers a better success rate: one in three patients receiving the procedure will go on to benefit.
The ability to restore better blood flow to the brain and more quickly has important consequences for patients: it can mean the difference between a patient who is left severely disabled, bedridden, incontinent, and in need of constant nursing care and attention, and a patient with little or no disability. For the health and social care services that pick up the tab of chronic disability, the difference is a patient who can go home within 48 hours, or one who might need to stay in hospital for several months, and then need intensive social care – at a total cost of thousands of pounds.
Dr Patankar believes that thrombectomy has the potential to reduce disability in a very wide range of ischaemic stroke patients, even in those whose brains are not expected to recover fully. His philosophy is “Brain is Brain”. But current availability of thrombectomy in England is very limited – to just a handful of centres and mostly during working hours – due to a combination of reluctance to adopt emerging technologies, funding concerns, and the need to redesign services so that patients are effectively managed into and out of specialist units offering this procedure. He says: “What we should be working towards is a 24/7, 365-day service: strokes do not clock-watch!”
He believes things are changing, and his hope is that by the end of the year – as evidence for this procedure grows – there will be significant progress towards his goals. In systems where the cost of stroke to the whole health and social care system is recognised, mechanical thrombectomy is much more prevalent. For example, in Germany, several thousand thrombectomies are performed each year. Dr Patankar says: “We are lagging behind other countries and it’s not good enough.”