Why do we need this project?
About 80% of strokes are caused by a blocked blood vessel. A third of these patients have a blockage of a large blood vessel in the neck or brain known as large artery occlusion stroke (LAOS). This often causes severe problems, but chances of recovery are greater if the blockage is removed quickly. It has recently been shown that pulling the blockage out of the artery (mechanical thrombectomy) within six hours of the symptoms starting is more effective than a clot-dissolving injection by itself (intravenous thrombolysis).
However, there are few hospitals providing thrombectomy, and most patients with a large artery blockage will need to be identified first at local stroke units and then taken to regional centres. An initial scan of the brain’s arteries (CT angiogaphy) and an additional ambulance journey is required. This often creates a delay of one hour before the patient arrives at the thrombectomy hospital, and chances of a good recovery will be lower than if they had been taken there directly. But as only 10% of stroke patients overall are suitable for thrombectomy, it would be inefficient for all to be taken directly to the regional hospital first.
What is the aim of this project?
The aim of this programme is to develop and test a new care pathway for paramedics to recognise those patients who are likely to have a large artery blockage, so that this group can be taken directly to the thrombectomy hospital.
What will happen during the project?
Assessment will reflect a combination of the best published evidence about symptom checklists to identify patients. This involves:
- A new fingerprick blood test for measuring natural chemicals (purines) which increase when body tissues are starved of oxygen, as higher levels may reflect blockage of a larger artery.
- The use of telephone or video in the ambulance to enable a hospital stroke specialist to review the patient; and stakeholder views about feasibility and acceptability.
What is the intended outcome of the project?
To increase the number of eligible stroke patients receiving thrombectomy in the UK, and improve their outcomes, by getting them to a thrombectomy hospital as soon as possible.
48 months (start date: 1 April 2017).