24 February 2016

NICE greenlights clot removal procedure for use on NHS

NICE has approved a procedure for use on the NHS that uses a mechanical device to remove clots from stroke patients.

Following new evidence on long-term safety and effectiveness, NICE has published updated guidance which approves mechanical clot retrieval for removing blood clots in people who have had an acute ischaemic stroke.

Stroke occurs around 152,000 times a year in the UK, is fatal in 1 in 4 cases, and one of the largest causes of disability.

Ischaemic stroke is the most common type of stroke and can happen when an artery blocked by blood clot, cutting off blood flow to part of the brain. Without blood supply, this can lead to brain cells being damaged or destroyed.

Symptoms may include numbness or weakness on one side of the body and problems with balance, speech, and swallowing.

Currently, treatment for ischaemic stroke is the use of drugs as soon as possible after the stroke to dissolve the blood clot. However, these must be given within 4.5 hours of the start of the stroke and only benefit around 1 in 7 people treated.

Clot removal within hours of stroke

Mechanical clot retrieval aims to remove the obstructing blood clot or other material from arteries in the brain. This helps restore blood flow and minimise and so prevent or limit the damage caused by the stroke

With the patient under sedation and local anaesthetic, or under general anaesthetic, a catheter is inserted through a large blood vessel, usually in the groin. The clot is located through a cerebral angiography – where dye and X-rays are used to see how blood through the arteries in the neck and brain.

The clot retrieval device is then inserted through a catheter, and positioned near the side of the clot. The aim is to remove the clot as soon as possible, within a few hours of the stroke.

‘Mechanical clot retrieval helped me with my recovery’

Gillian Johnson was partially paralysed after suffering a stroke in 2015. She has since made good progress which she attributes to receiving the clot retrieval procedure.

She said: “I am now 5 months post stroke. I walk and swim daily, and go to the gym every other day. I have managed my own recovery without the need for support from the physios at the hospital. I am hoping to return to work next month to support myself financially as well rather than relying on financial assistance.

“In my opinion the amazing recovery I have made is purely because of having undergone this procedure. I pray that it becomes more widely available on the NHS, as I believe it is only available at 28 hospitals throughout the UK.  It saves lives and vastly improves quality of life, which in turn saves money for both the NHS and the government in terms of benefit payments."

Read more about Gillian’s experience and that of other ischaemic stroke patients who have undergone this procedure.

NICE recommends procedure following new evidence

Mirella Marlow, Programme Director – Device and Diagnostics Systems at NICE, said: “In England, approximately 110,000 people have a stroke each year. It’s the fourth single largest cause of death and is the largest cause of complex disability, with limited available treatments. We are therefore pleased to be able to recommend normal arrangements for this procedure.

“When we originally looked at this in 2013 there was not enough evidence for us to advise that it worked well enough and was safe enough.

“At the time, we encouraged clinicians to collect more data to provide us with further evidence of the procedure’s long-term safety and effectiveness.

“We’re pleased that specialists took notice of our recommendation and recorded this information – this has contributed to NICE now being able to recommend this procedure with normal arrangements for clinical governance, consent and audit.”

Alexis Wieroniey, Deputy Director for Policy and Influencing at the Stroke Association said: “The NICE guidelines on use of mechanical clot retrieval (thrombectomy) are a very welcome development in the treatment of stroke. Although a relatively small number of patients will be eligible for this procedure, research shows that the outcomes for those patients are often very good and better than they would have been without the intervention.

“Stroke treatment has improved over the last 20 years but it can still be a deadly and devastating condition; 1 in 8 strokes is fatal within thirty days and for people who do survive, half will be left with a disability, so new and innovative treatments such as thrombectomy are very much needed. NICE guidelines set the stage for thrombectomy to be used on the NHS and we would like to see the procedure routinely commissioned in all areas. Every stroke patient should have access to the same high quality care, regardless of where they are treated.

“Thrombectomy is a highly skilled operation and stroke services need to be set up to be able to deliver the treatment. It is essential to have a new national stroke strategy to ensure this breakthrough procedure is made widely available and to drive improvements in stroke care.”