There is overwhelming evidence that mechanical thrombectomy (MT) for the treatment of acute ischaemic stroke (IAS) due to large artery occlusion (LAO) – 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.
In an era when we have grown accustomed to eking out marginal gains for patients from small advances in existing treatments, MT for IAS represents an extraordinary leap forward.
The evidence base behind MI for anterior circulation LAO stroke is clear and unequivocal, with 11 randomised controlled trials published since 2015 demonstrating substantial benefits over best medical therapy. The compelling evidence for MT in patients presenting within six hours of onset has been joined by high quality evidence for benefit in highly-selected, late-presenting patients.
There is a palpable sense of urgency in the stroke world at these new opportunities to spare many people from major disability, with MT offering a dramatic change in the management of the largest cause of adult disability and the third biggest killer in the UK.
MT is the archetype of ‘disruptive innovation’, but we can only achieve the step change in treatment that is urgently needed through unprecedented system-wide collaboration and innovation. In short, the challenge is implementation.
In 2019 we published our first guide to support accelerated uptake of this high-value treatment by distilling the best available expertise within the UK into a single definitive volume. It was edited 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,
There has been steady growth in use of MT since then but the pandemic has held back progress. The ambition set out in the 2019 NHS Long Term Plan for a ten-fold increase in MT by 2022 will not be achieved.
In February 2022 the editors published an updated second edition of the MT implementation guide. It brings together the most incisive evidence and analysis, practical experience from early adopters, and lessons learned from earlier cardiology and stroke service reorganisations. There is also a new chapter on the response to the pandemic. A webinar to mark the launch of the second edition took place on 1 March 2022. Click on the image at the top of this page to watch a recording.
Download Mechanical thrombectomy for acute ischaemic stroke: an implementation guide, 2nd edition (Feb, 2022), pdf