Mechanical thrombectomy implementation guide for the UK launched

Mechanical thrombectomy for acute ischaemic stroke: an implementation guide for the UK has been published, bringing together evidence, analysis, and practical experience to support rapid uptake of mechanical thrombectomy (MT) across the UK.

The NHS Long Term Plan, as part of the strategy for modernising stroke care, includes a target to expand MT services to cover 10% of patients with stroke, compared with 1% presently. The plan highlighted MT as an important and highly effective treatment that reduces the severity of disability caused by stroke, and also committed to modernise the stroke workforce—including working with Health Education England to train eligible consultants to offer MT.

England heatmap of mechanical thrombectomy coverage
Figure 1: Heat-map of access to MT-capable neuroscience centres in England. Rapid access to suitably equipped neuroscience centres is one of the barriers to implementation
© OpenStreetMap contributors
Reproduced under the terms of the Creative Commons BY-SA 2.0 licence

Uptake of MT has nonetheless been slow, with only a fraction of patients with stroke in England and Northern Ireland receiving MT, and in Scotland and Wales, there are no services providing this emergency treatment at all. Like thrombolysis when it was first introduced, MT is seen as a ‘disruptive innovation’ that requires incorporation into existing care pathways that may need to be changed significantly to adapt. However, there is a substantial body of evidence supporting the need to adopt MT, and the benefit to both patients and the NHS is clear.

Overcoming the barriers to the uptake of mechanical thrombectomy

This implementation guide is the culmination of a collaboration between experts, and was edited by Professors Gary Ford, Martin James, and Phil White. The guide aims to address a number of key challenges that have slowed the adoption of MT, and better inform similar services about effective ways to speed up the integration of MT into their care pathways.

Gary Ford, Chief Executive Officer of the Oxford AHSN and co-editor of the implementation guide, said:

‘We have a once-in-a-generation opportunity with mechanical thrombectomy for acute ischaemic stroke to alter the miserable prognosis for the most devastating form of stroke, with substantial benefits for individuals and for wider health and social care.’

How the guide can help

Using the latest evidence and analysis, practical experience from early adopters, and lessons learned from previous roll-outs of stroke treatments, the guide explores:

  • evidence supporting the use of MT in acute ischaemic stroke
  • how many patients in the UK are eligible for MT, and how many primary and comprehensive stroke centres the UK should have to be able to reach them
  • building up the MT pathway, including:
    • organising ambulance services
    • diagnostic imaging and resource implications
    • establishing a regional MT service
  • lessons and learning points from previous service developments and from early adopters, including:
    • the implementation of primary percutaneous coronary intervention for myocardial infarction, and intravenous thrombolysis for acute ischaemic stroke
    • planning and implementing major reconfigurations in acute stroke services in London and Greater Manchester, and establishing a 24/7 interventional neuroradiology service to deliver hyperacute stroke care in North Staffordshire
  • developing a business case for MT.

Expressing the Stroke Association’s support for the guide, Julia Bouverie, Chief Executive, said:

The Stroke Association firmly believes thrombectomy to be a game-changing intervention that could and should act as a catalyst for change and improvement across the whole pathway. I hope this new “how-to” guide will provide the evidence and information the NHS needs to help make thrombectomy a routine option for stroke treatment for the benefit of people affected by stroke across the UK.

Specialised Commissioning has previously covered the opportunities and challenges presented by mechanical thrombectomy. You can find an in-depth discussion of this revolutionary treatment in Dr Dipankar Dutta’s article, Mechanical thrombectomy: a breakthrough in acute stroke treatment.