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In this issue, Werring et al1 have set out the evidence, patient selection and technique of one of the most effective new treatments in stroke medicine, with a ‘number needed to treat’ of fewer than three for improved functional outcome. The UK’s National Institute for Health and Care Excellence (NICE) (February 2016)2 and the Royal College of Physicians of London (October 2016)3 have each issued guidelines on its uptake, but these are purely advisory. In April 2017, National Health Service (NHS) England announced that it will commission mechanical thrombectomy. This is likely to be one of the biggest funding commitments that NHS England specialised commissioning has ever made: over £100 million per year when fully implemented, but balanced by massive life-changing patient …
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