More patients eligible for effective stroke treatment under new guidelines

Seven years on from its previous release, new National Clinical Guidelines for Stroke in UK and Ireland have been issued, detailing new and important parameters for healthcare professionals to adhere to.

The updated guidelines, which are central to improving stroke care, recommend changes in four key areas: the organisation of stroke services; acute care; rehabilitation and recovery; and long-term management and secondary prevention.

It is estimated there are around 100,000 strokes every year in the UK and stroke is a leading cause of death and disability, causing around 38,000 deaths each year.

Ischaemic strokes, which are the most common kind, are often treated with reperfusion therapy, a medical treatment that removes the clot and restores blood flow.

The most common treatment is thrombolysis, where clot dissolving medicine is given. In some cases, a patient will not be eligible for thrombolysis, but they may be eligible for mechanical thrombectomy, an interventional treatment that works by removing the blood clot blocking the artery to the brain, using aa catheter inserted into an artery. The treatment can reduce brain damage and prevent long term disability.

Key changes

The new guidelines expand the eligibility criteria for thrombolysis and mechanical thrombectomy.

The key points are that:

1. Generally, thrombolysis should be done as soon as possible, but usually within four and a half hours of onset of stroke; and
2. Thrombectomy should be done as soon as possible, and usually within six hours of stroke onset.

It is now recommended that patients who present with acute ischaemic stroke within 12 hours of onset, and who are suffering with an occlusion (a blocking of a blood vessel) in a particular part of their brain, should also be considered for mechanical thrombectomy.

Depending on a patient’s ASPECTS scores, a scoring system used to measure changes to the brain, this treatment should also be considered for patients who:

• present with acute ischaemic stroke and large artery occlusion (which is also causing neurological issues);
• between six and 24 hours (including “wake-up stroke”, where the exact time of onset is not known by the patient); and
• have no previous disability

Importantly, the guidelines highlight that patients with suspected acute stoke should receive brain imaging as soon as possible, and not more than 1 hour after they arrive at hospital.

Patients suffering from an ischaemic stroke should undergo a CT angiogram immediately. This test combines a CT scan with an injection of dye to produce pictures of blood vessels and tissues to help identify which part of the brain is affected. The guidelines acknowledge that imaging is central to the decision of what treatment options are available to the patient.

Why does this matter?

The new guidelines means that around 9,000 more patients each year could receive life changing treatment.

Proper availability of thrombectomy could also save the NHS millions of pounds a year due to the reduced costs of looking after people with stroke.

However, concerns have been raised by clinicians and the Stroke Association that even before these new guidelines were published, thousands of eligible patients each year were missing out thrombectomy treatment because of ambulance and A&E delays or failures in the radiology resources needed for the treatment to be provided.

Continuing shortages in the UK healthcare workforce are likely to lead to increased delays for stroke patients at various stages and so even if patients do undergo thrombectomy they might not have the best possible outcome.

As medical negligence lawyers, we regularly see the life-changing impact that substandard care has which is why it is reassuring to see the new guidelines’ emphasis on managing strokes with urgency.

Too often, we support clients who have not received the treatment they needed soon enough. Where appropriate, we work to obtain compensation for our clients to cover the financial consequences of substandard care including medical treatment, therapies, accommodation, equipment and aids.

This was the case for a 59-year-old electrician I acted for who suffered a stroke the day after knee surgery and missed out on treatment which would have given him the best chance of recovery. Leigh Day argued that had he been urgently transferred to a larger hospital and received the necessary emergency treatment, it was likely that he would have made a near complete recovery. Instead, he suffered serious impairments.

If there were delays in your care, which meant that treatments could not be given to you, or you are concerned generally about the standard of stroke care you received, please get in touch.