Exeter clinicians, researchers help shape stroke services

Professor Martin James, a senior NHS clinician for strokeservices in Exeter, England, and a team of researchers at the University ofExeter Medical School, funded by the National Institute for Health Research(NIHR), have undertaken research to identify the best possible treatments andoutcomes for stroke patients alongside the best use of resources andfacilities. This research, together with the contribution of stroke charities,local patients and staff, has informed the Department of Health’s options tocreate a sustainable network of hyper-acute stroke units intended to deliver betteroutcomes.

NHS guidelines in England recommend that when reconfiguringstroke services patients should ideally be within 30 minutes of a hyper-acutestroke unit, and no more than 60 minutes away. A stroke is a seriouslife-threatening medical condition that occurs when the blood supply to part ofthe brain is cut off, and the sooner a person receives treatment for a stroke,the less damage is likely to happen.

The research by Professor James and the Exeter team looks atthe best way to deliver the combined life-saving treatments of thrombolysis andthrombectomy for stroke patients. Thrombolysis is a clot-busting medicine, andin thrombectomy the doctor uses a tiny stent to snare the clot that can then beremoved from the blood vessel in the brain.

Thrombectomy is a new treatment that can significantlyincrease the chances of a good outcome for patients who suffer a major stroke,and is the appropriate treatment for about 1 in 10 people who suffer a stroke.But this procedure requires expert clinical services that can only be providedat a relatively small number of centres in the U.K.

The University of Exeter Medical school team developedcomplex models to test a range of options that took into account speed andquality of service, travel times and access to the single thrombectomy centreat the Royal Victoria Hospital (RVH) in Belfast. The research team tested arange of options whereby a patient either directly attends the specialistthrombectomy centre at the RVH first or attends a more local hyper-acute strokeunit for thrombolysis, and is then transferred to the thrombectomy centre ifappropriate.

The Exeter research team found that the current serviceprovision across eight acute hospital sites could be optimised. Not all strokeunits are able to offer the same level of service, and patients benefit mostwhen they get the faster access to thrombolysis achieved in the larger unitscoupled with the use of thrombectomy for appropriate patients. The research hasfound that this combination can be expected to nearly double the clinicalbenefit for the population of Northern Ireland compared with currentperformance.

Prof James and his team looked at options that includedthree, four or five hyper-acute stroke units - all including the thrombectomycentre at the RVH. The three-month public consultation was launched on Tuesday,26th March, at Stormont by the province’s Chief Medical Officer, Dr MichaelMcBride.

Professor Martin James says: “There is strong clinicalevidence and research that shows by providing stroke care in specialist centreswith the right clinical experts and new treatments, we can save lives andprevent serious disabilities. Our sophisticated modelling work is designed togive policy makers, clinicians and communities in Northern Ireland the qualityinformation they need to make some major decisions about how to provide strokeservices for the future.”