Improving stroke care in Norfolk and Waveney.

It is a sobering statistic that one third of all patients who suffer a stroke will have permanent disability and require long-term care.

Most strokes are ischaemic caused by a blood clot blocking an artery in the brain, depriving the brain of its blood supply and nutrients resulting in brain damage. Many of us will be aware of ‘act FAST’ when a someone displays one of the symptoms of stroke and how every second counts to treat and remove a clot in someone’s brain.

Our stroke and radiology teams are in the advanced stages of launching a new treatment at NNUH, which will help to improve patient outcomes for people who suffer a stroke in Norfolk and Waveney.

The new treatment, described as a “game changer” for stroke, involves the removal of a clot from the blood vessel using catheters (small tubes) inserted from the patient’s leg into the brain.

We have received approval and some funding from NHS England to offer mechanical thrombectomy at our Trust, which represents a major expansion for our Neurosciences services.

One in ten patients who have a clot in the main trunk of the brain would benefit from mechanical thrombectomy and there’s a six-hour window to treat a stroke patient.

Currently, patients suitable for this treatment are transferred to Cambridge or London.

Mechanical thrombectomy is proven to reduce the risk of long-term disability with the majority of patients being able to live independent lives in their own homes following thrombectomy.

Stroke Consultant Joyce Balami, who has worked at NNUH for the last ten years, said: “We know that stroke is a leading cause of disability and an enormous economic burden to individuals and society. Worldwide, 15 million people are affected by stroke and at NNUH, we have 1,200 admissions a year.”

“We know that with stroke for every minute that passes without treatment, two million brain cells are at risk of dying and a third of patients who have a stroke are permanently disabled and need long-term care.”

The recognised treatment for strokes is using clot busting medication to dissolve clots and return blood flow in the brain, but if this is in the main pipe in the brain, clot busting treatment may not dissolve the blood clot.

Dr Balami added: “Thrombectomy is a game changer for stroke treatment and will significantly reduce disability, reduce length of stay in hospital and the amount of therapy required. 94% of patients who have thrombectomy are discharged back to their own home and do not require a community or care home bed.

There are currently 24 specialist neurosciences centres in England resourced with the latest equipment and skilled staff to carry out mechanical thrombectomy. The procedure is performed by interventional radiologists.

We have the stroke team at NNUH to identify suitable patients and the radiology team to carry out imaging scans of the head.

The next step is training and bringing in interventional neuroradiologists to NNUH and carrying out building work on level 3 of the hospital to get the service ready and running by the end of 2024.

“I have been involved since 2016 and participated in research that helped make the case for stroke thrombectomy, which is now NICE recommended. It would be a dream come true for this to become a reality and would be a life achievement to see patients getting the treatment they need,” said Dr Balami.

Fundraising for additional equipment by the N&N Hospitals Charity and Neurosciences team to prepare for the service at NNUH is taking place.

This is for the expansion of neurosciences at the Trust and to help our doctors, nurses, therapists and outreach teams with the latest technology, medical equipment and training so that they can provide even better care for Norfolk patients.