Strokes are the second most common cause of death worldwide. 85% of strokes are caused by a blockage (a clot called a thrombus) in the small blood vessels of the brain, and the remaining 15% occur as a result of a bleed in the brain. Administering emergency clot-busting drugs has been the mainstay treatment for many years but risks further complications. Developments in treating these thrombolytic strokes continue to improve not only survival, but the quality of life for those that do survive.
Some thrombolytic strokes are now treated using a relatively new procedure, similar to that used in the treatment of heart attacks. Removal of the thrombus is undertaken with a guide wire inserted into a large artery in the leg, which travels along blood vessels to reach the target, and the thrombus is removed. This procedure is called Mechanical Thrombectomy Retrieval (MTR) and is performed by specialist Neuro Interventional Radiologists at Plymouth hospital, using x-ray type images to help them carefully navigate the complex network of blood vessels in the brain. The aim is to remove the thrombus, so that normal blood flow can be restored to the part of the brain which has been starved of oxygen.
Results for MTR are impressive. In some cases, patients can have severe one-sided paralysis at the start of the procedure and wake up afterwards moving all four limbs normally. Patients suffering this kind of sudden stroke are time critical, and MTR should be performed as quickly as possible as the benefit of MTR drops by 5.7% for every hour of delay. In Devon, the longest transfer time to Plymouth hospital is undertaken by patients being treated at Barnstaple hospital. Between the two hospitals, the road transfers can take up to two hours, but by air, it is only twenty minutes.
Anaesthetist, Anna Ferguson, first approached Devon Air Ambulance with the idea of reducing this transfer time. In partnership with Plymouth and Barnstaple hospitals, Critical Care Paramedic, Nigel Lang, from Devon Air Ambulance, worked with Anna to develop the system which now provides rapid air transfer for these time critical emergencies.
So far, six patients have benefited from this new service, and it is anticipated that numbers will increase as the MTR service expands. MTR is not yet a 24/7 service, however it is hoped this will be achieved within the next few years. MTR is an expensive procedure, however due to reduced hospital stay and social care needs, cost savings can be huge; and the benefit to patients and their families can be even bigger.
The main stroke symptoms can be remembered using the word FAST:
Face – their face, mouth, or an eye may droop on one side, and the person may not be able to smile.
Arms – the person may not be able to lift both arms and keep them there.
Speech – speech may be slurred or garbled; they may not be able to talk; and may have problems understanding what you’re saying.
Time – dial 999 immediately.
About Nigel Lang: Nigel has been with DAA for since 2009, and an operational Advanced Paramedic in Critical Care, as well as the Research Lead Paramedic.
How to identify a stroke infographic
