NHS thrombectomy plan needs more doctors, say stroke experts

Stroke experts have warned that not enough doctors are trained to carry out mechanical thrombectomy, after NHS England announced that the procedure will be performed on all patients who have had acute ischaemic stroke.

NHS England said that the procedure, which involves removing a blood clot from the brain using a stent, would be introduced in 24 specialist neuroscience centres throughout the country from this year, eventually benefiting around 8000 patients a year.

The Royal College of Physicians first recommended mechanical thrombectomy for patients with acute ischaemic stroke in guidelines last year.1 A systematic review and meta-analysis in The BMJ found that the procedure, if performed within six to eight hours of a stroke occurring, produced functional benefits with no detrimental effects, when compared with medical care alone.2

Martin James, associate director of the Royal College of Physicians’ stroke programme, said that the plan to commission the procedure was “very welcome indeed” but added, “There remain substantial challenges to its implementation—not least the relatively few doctors trained to perform the procedure, fewer than 100 in the whole UK.

“What we urgently need now is for NHS England to take the lead and invest in the additional capacity of doctors and centres to ensure that the more than 8000 patients a year who are eligible can actually receive the treatment.”

NHS England said in a statement that the treatment will be phased in later this year with an “estimated 1000 patients set to benefit across the first year of introduction.” NHS England will work with Health Education England and health trusts to “build on the expertise that is currently available in these specialised centres, developing the workforce and systems to enable an estimated 8000 [people] to receive this treatment in coming years.”

Nicola Strickland, president of the Royal College of Radiologists, described the procedure as an “amazing, disability sparing treatment” but said that NHS England had not indicated how its plans would be achieved.

She said, “Interventional neuroradiologists are the doctors who perform this intricate and lifesaving procedure. We are already facing a severe shortage of radiologists across the board in this country . . . We need the necessary investment in our workforce to make sure as many patients as possible can benefit from it.”

Juliet Bouverie, chief executive of the Stroke Association, described thrombectomy as a “game changer” but added, “Its delivery across England will need significant changes to NHS stroke services, as well as an increase in the number of trained professionals who can carry out the procedure so that as many people as possible can benefit from this powerful new treatment.”

Simon Stevens, chief executive of NHS England, said, “This major national upgrade to stroke services puts the NHS at the leading edge of stroke care internationally. It’s another practical example of the NHS quietly expanding innovative modern care that will really benefit patients, but which tends to be invisible in the public debate about the NHS.”