NNUH Consultant developing stroke services of the future

A stroke consultant at Norfolk and Norwich University hospital is part of the team leading the design and delivery of advanced stroke services across the UK.

Dr Joyce Balami, a Consultant Stroke Physician at NNUH, has been involved in significant research into mechanical thrombectomy, an interventional treatment for ischaemic stroke. The procedure, which removes blood clots in the brain, involves inserting a catheter into an artery, often in the groin. A small mechanical device, controlled from outside the body, is passed through the catheter into the artery in the brain to remove the blood clot.

Mechanical thrombectomy is a relatively new development in treatments for strokes where a blood clot is preventing oxygen reaching the brain and requires the expertise of an interventional radiologist.

February 2015 saw the publication of the results from five separate clinical trials which demonstrated the effectiveness of this new surgical treatment for ischaemic stroke. Dr Balami published a research paper (systematic review and meta-analysis) of the initial five positive trials of the new clot retrieval technique and this formed part of the basis of the guidelines issued by NICE in February 2016 which recommended the treatment.

Over the last 24 months, Dr Balami has been working as a member of a research team drawn from the Universities of Newcastle, Oxford and Northumbria to construct an affordable, effective and safe model for the delivery of mechanical thrombectomy within the NHS in England.
Dr Balami’s contribution has included the analysis and evaluation of data concerning the use of the clot retrieval treatment in the clinical setting.

In May 2017, Dr Balami travelled to the European Stroke Organisation Conference, held in Prague for more than 4,000 delegates from around the world. She presented the group’s findings demonstrating the clinical effectiveness and safety of the new treatment in the UK.

The group had established that clot retrieval via Mechanical Thrombectomy is a clinically effective and a safe treatment for stroke and findings show the UK performed very well in terms of clinical outcomes when compared with other clinical trials across the world.

The research team’s next challenge is to address the availability of thrombectomy services across England. As a highly specialised technique, which requires significant expertise from a multidisciplinary team and state of the art facilities, the treatment is currently only available in 29 Neuroscience Centres across the UK of which 25 are in England. NNUH is currently progressing with plans to develop a dedicated thrombectomy service in Norwich.

Already around 10,000 people each year require the treatment and with an ageing population, it is likely that this figure will increase.
Dr Joyce Balami said, “As stroke physicians we are continuously striving to develop new services which benefit our patients and deliver sustainable outcomes. I’m proud to be part of the team helping to shape the development of enhanced stroke services which are fit for the future.”

Dr Frankie Swords, NNUH Chief of Division for Medicine, said: “At NNUH we are proud to have clinicians who are experts in their field working as part of our multidisciplinary teams. Dr Balami’s knowledge of and dedication to developing innovative new services for stroke patients is a great asset to our hospital and I would like to congratulate her on the positive impact of her work so far.”

NNUH is one of the five largest combined stroke units in England. Care ranges from emergency assessment and treatments in the first few hours after stroke, including clot-busting thrombolysis therapy, to rehabilitation including physiotherapy, occupational, speech therapy and psychology.

A device (Stent) with embedded blood clot in a blocked brain vessel pulled out into a guide catheter via the groin.