Stroke surgery - a brave new world?

'Clot-busting' surgery for stroke could soon be as much part of daily hospital life as it is for heart attack. When I was a medical student back in the 1980s, I remember learning about revolutionary new 'clot-busting' drugs. They could dissolve the clots that block off one of the arteries supplying blood to the heart in heart attack, allowing blood to flow freely.

Time is muscle

But time was of the essence - with heart muscle dying within minutes of being deprived of blood, we soon learnt that where heart attack treatment was concerned, time is muscle. Hospitals routinely have 'door to needle' targets, ensuring as many people as possible have blood supply restored to the heart muscle in time.

And while these drugs are effective, they're also something of a blunt instrument. All the blood in the body is affected by the blood-thinning medicine, and complications are not uncommon.

Stroke surgery

Over the last few years, though, more and more hospitals have moved on to a more targeted approach. They remove the clot physically, using a tiny tube threaded up through an artery under X-ray control. And more recently still, we've been using the same procedure for strokes.

This mechanical thrombectomy, carried out under sedation, involves first locating the clot in the brain and working out which artery offers the safest chance of reaching it. A thin tube is fed into an artery, usually through the skin at the groin, and threaded up into the blocked artery in the brain. A tiny mesh basket called a clot retrieval device is then passed up the tube, grabbing the clot and holding it firmly while it's pulled out.

Until now, this highly specialised procedure has only been available on the NHS at a handful of hospitals. But now the NHS has approved a roll-out to dozens of hospital centres with staff on call 24 hours a day. The team includes the interventional radiologist (X-ray specialist doctor) who ensures the team can pinpoint the clot precisely.

Doctors at St George's Hospital in London have been trialling a 24-hour service for stroke mechanical thrombectomy. They suggest that in the right patients it offers an 80-90% chance of opening up the blocked vessels and allowing blood to flow again. And a study last year in The Lancet showed 50% of patient treated with this procedure showed improvement in their stroke symptoms within a day. This compared with about 20% treated with medicines used to dissolve the clot.

Think FAST

More than ever, then, we should be treating a stroke as a 'brain attack' - every bit as much an emergency as a heart attack. Surgery only works within six hours of the stroke. Brain tissue starts dying within minutes of being deprived of oxygen, and it take a matter of hours for clots to become 'organised', firmly attached to the artery wall.

So everyone needs to know the signs of stroke - and you need to know it FAST (or BE FAST, to be even more accurate). Here are the signs to look out for:

  • B - balance. Is the person affected suddenly off-balance, or uncoordinated?
  • E - eyes. Have they suddenly lost vision or developed blurred or double vision?
  • F - face. Does one side of their face droop when they try to smile?
  • A - arms. Do they have problems raising both arms and keep them there?
  • S - speech. Is their speech slurred, or are they having trouble finding the right words?
  • T - time. If they have any of these symptoms, it's time to call an emergency ambulance - NOW.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.