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Mechanical thrombectomy for acute ischaemic stroke: an implementation guide for the UK

There is overwhelming evidence that mechanical thrombectomy (MT) for the treatment of ischaemic stroke due to large artery occlusion (blockage of one of the major arteries in the brain, causing a severe stroke) is highly effective and could benefit at least one in ten patients admitted to hospital with an acute stroke.

However, implementation of MT across the UK has been limited, with only 1,200 MT procedures in England and Northern Ireland last year (April 2018-March 2019), representing just 1.4% of all people with acute stroke (one in 71 stroke patients). In Scotland and Wales, there are no services providing this emergency treatment at all.

While the right moves have been made in terms of a National Commissioning Policy for MT from NHS England and the National Stroke Programme, which underpins NHS England’s NHS Long Term Plan, there are still significant challenges in rolling out this service across the UK.

Mechanical Thrombectomy for Acute Ischaemic Stroke: an Implementation Guide for the UK has been developed by Professor Gary Ford, Chief Executive of the Oxford AHSN, Professor Martin James, a Consultant Stroke Physician at the Royal Devon and Exeter NHS Foundation Trust, and Professor Phil White, Consultant Neuroradiologist at The Newcastle upon Tyne Hospitals NHS Foundation Trust, to accelerate the uptake of this high-value treatment by distilling the best available expertise within the UK into a single definitive volume.

The guide brings together evidence and analysis, practical experience from early adopters, as well as lessons learned from earlier cardiology and stroke service reorganisations related to delivering primary percutaneous coronary intervention for heart attacks and intravenous ‘clot-busting’ treatment for stroke a decade ago.

The guide focuses on:

  • the research evidence for mechanical thrombectomy in acute ischaemic stroke
  • how many stroke patients in the UK are eligible for mechanical thrombectomy
  • how many comprehensive and primary stroke centres should the UK have
  • organising ambulance services for effective implementation of mechanical thrombectomy
  • imaging for stroke thrombectomy and resource implications
  • lessons from the implementation of primary percutaneous coronary intervention for heart attacks
  • establishing a 24/7 interventional neuroradiology service to deliver hyperacute stroke care
  • lessons from the implementation of intravenous thrombolysis for acute ischaemic stroke
  • planning and implementing major system change in acute stroke services: lessons from the London and Greater Manchester reconfigurations
  • establishing a regional thrombectomy service and developing a business case for mechanical thrombectomy.

Download a copy of the guide here