In January this year, Deb Kelly, a prison officer and physical education instructor, collapsed in her home with a stroke. Kelly, 53, a committed runner, was at risk of permanent paralysis or even death. Her speech was slurred, her face was drooping and she had lost significant movement in her left side.
Her family called an ambulance and she was taken to the Royal Stoke University hospital, where she was given a treatment called mechanical thrombectomy to remove the blood clot in her brain that had caused the stroke.
A few days later, she was discharged, with her speech restored and the movement regained in her left side. “I walked out of hospital, which is unbelievable, knowing what could have happened if I hadn’t been treated quickly enough.” Doctors told her she would probably have died without treatment or have been left in a minimally conscious state.
Most strokes are caused by blood clots, and mechanical thrombectomy is suitable where the blockage is in a larger artery. Under the procedure, a small wire and tube are inserted into an artery in the groin and manoeuvred towards the brain to pull out the clot.
There are now 24 centres across England offering the service, 10 of which give 24-hour access to the treatment, including units in London, Bristol, Birmingham and Greater Manchester, according to a survey conducted by the UK Neurointerventional Group (UKNG), a body that represents specialist doctors with an expertise in mechanical thrombectomy and that is affiliated to the Royal College of Radiologists (RCR).
The number of procedures in England increased from 1,490 in 2019-20 to 2,684 in 2022-23, a rise of 80%.
It is a dramatic increase in access compared with seven years ago when the treatment was first being championed by a small group of consultants, but experts are calling for a faster rollout to save more lives and prevent permanent disability.
Dr Hannah Stockley, honorary secretary of the UKNG and a consultant at Salford Royal hospital in Greater Manchester, said: “Despite the pandemic, we have been able to expand services and work towards providing this service for more people.”
Stockley said more investment was required from NHS England. At least 10% of stroke patients are suitable for thrombectomy in England, but only 3.3% receive it, according to charity the Stroke Association, based on data from the Sentinel stroke national audit programme.
Clinicians, patients and the Stroke Association say there are large variations across the country in getting access to treatment. In London, about 9.8% of stroke patients benefit from the treatment compared with 0.4% in the east of England.
The NHS long-term plan published in January 2019 aimed to deliver a tenfold increase in the proportion of stroke patients receiving mechanical thrombectomy by 2022, but missed the target. There are more than 100,000 strokes every year in the UK.
Dr Sanjeev Nayak, a consultant neuroradiologist who set up the first 24-hour mechanical thrombectomy service at Royal Stoke University hospital, said: “There are still thousands of patients who are missing out on this treatment. They could be walking out of the hospital, and they are being disabled or they are dead because of lack of access to this lifesaving procedure.”
Peter Hooper, 63, who had a stroke in June 2020 and was treated by Nayak, is among those calling for greater access. “I was in theatre with Sanjeev and his team within two or three hours of my stroke,” said Hooper.
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“I had the thrombectomy on Sunday morning, the physio team were working on me on Monday morning and I walked out of the hospital on Monday afternoon. It was incredible, but it is a postcode lottery.” Hooper, who would have been seriously disabled without the treatment, has since run two half marathons, raising money for the Stroke Association.
Dr John Stephens, 60, a GP who lives near Blandford in Dorset, had a stroke in September 2021 and was given a thrombectomy at Southampton general hospital. He said within six months he was able to sail and go walking in the Alps. He said: “You would not have expected this sort of recovery in the past.”
Stephens said he was lucky to benefit from the treatment and wanted to promote wider access. He said there was work to ensure more doctors could deliver the service, including a new professional credential sponsored by the RCR for clinicians from non-radiology specialties to perform the procedure, but there also needed to be more investment in patient rehabilitation after treatment.
The Stroke Association says it applauds the work of thrombectomy teams who have “worked tirelessly” to improve access, but says it should be a “rallying cry” for a wider rollout of 24-hour services. Juliet Bouverie, chief executive of the Stroke Association, said: “Thrombectomy is a miracle treatment that transforms recovery, significantly reducing the chance of disabilities like paralysis, visual impairment and communication difficulties.
“It is unacceptable that whether you can have a thrombectomy still depends on where you live and when you have your stroke. Fast access to thrombectomy should be available for all stroke patients who would benefit, so that more people have the best possible chance of recovery.”
The national clinical director for strokes at NHS England, Dr Deborah Lowe, said: “Mechanical thrombectomy is a gamechanging treatment for stroke patients, which can dramatically improve outcomes and reduce disability, and the NHS remains on track to achieving a tenfold increase in delivering this for eligible patients, with over a third of thrombectomy centres currently offering 24/7 services and all others actively working to provide this level of access right across England.
“The NHS is also taking further steps to ensure people receive prompt treatment for stroke, including the deployment of AI tools supporting real-time interpretation of brain scans and video triage linking ambulance teams with stroke specialists to guide rapid and informed decision-making and allow more patients to get the right treatment, in the right place, at the right time.”
