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The first thrombectomy for stroke was carried out in Beaumont Hospital in Dublin in 2010 and the service, which is provided 24/7 continues to grow from strength to strength. Thrombectomy is also carried out in Cork University Hospital (CUH) during working hours.
Unlike thrombolysis, which uses drugs to try and dissolve a blood clot, thrombectomy is a radiologically guided interventional procedure where doctors use specialist equipment to mechanically remove the clot from the brain.
Crucially unlike thrombolysis, which is only effective up to four and a half hours post stroke, thrombectomy has been shown to be effective up to 24 hours. This means that more patients will have the opportunity to receive the treatment.
However, it is essential to remember that Time Is Brain, and every minute counts.
Studies have shown that in eligible patients, thrombectomy can reduce the death rate from stroke by half and almost doubles the rate of recovery to complete independent living.
Time Is Brain and every minute counts
The National Thrombectomy Service (NTS) annual report for 2019, which was published recently, shows that a total of 306 patients received a thrombectomy in Beaumont Hospital and 78 patients were treated in CUH last year. This is a significant increase on the 2018 figures of 248 for Beaumont and 31 for Cork. Almost half or 47 per cent of patients who received a thrombectomy in 2019 returned to living a fully independent life after the procedure.
In 2019 there were 4,533 ischemic stroke discharges from public hospitals in Ireland, giving a thrombectomy rate of 8.3 per cent. This is increased from a rate of 6.6 per cent in 2018 and 5.6 per cent in 2017.
The annual report found that door to needle times is 50 minutes nationally for all patients who underwent thrombectomy. This figure is stable from 2018 figures.
The report also outlines a new protocol that has been tested in Naas General Hospital (NGH) which involves the ambulance crew that brings the stroke patients to NGH waiting for the decision as to whether the patient is suitable for thrombectomy, and when appropriate immediately transferring to Beaumont. This has resulted in a decrease in door in door out time (median time from arrival in the primary hospital to departure to a thrombectomy centre) from 96 minutes to 48 minutes.
A total of 306 patients received a thrombectomy in Beaumont Hospital and 78 patients were treated in CUH last year.
“It is an excellent achievement with very efficient workflows and positive feedback from Ambulance services. The National Thrombectomy Service QI Project has been working towards the aim of achieving door to decision in 30 minutes for all hospitals so that the ambulance waiting protocol could be extended,” the report stated.
On a national level, the QI project has been successful in reducing the door to decision time from 71 minutes in 2018 to 37 minutes in 2019.
Dr John Thornton, Consultant Interventional Radiologist and Director of the National Thrombectomy Service (NTS) at Beaumont Hospital in Dublin said he was pleased with the increased numbers of people being referred for and receiving thrombectomy, and that outcomes for patients continued to match best international experience.
He paid credit to all the stroke leads and stroke nurses in hospitals around the country who he said “do tremendous work on behalf of their patients to optimise patient care”.
Despite the COVID-19 crisis, Beaumont maintained a full thrombectomy service and an audit by Dr Jack Alderson revealed that the numbers of people who came directly to Beaumont for a thrombectomy was up during lock down compared to the same period last year.
The NTS annual report for 2019 is available on the HSE National Clinical Programme for Stroke website
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