Priority 6 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY:  How can the proportion of patients with ischaemic stroke who get clot retrieval (thrombectomy) be increased either by using new ways to identify more patients that are eligible, or by increasing the number of specialist healthcare professionals who can carry out thrombectomy? (JLA PSP Priority 6)
Overall ranking 6
JLA question ID 0106/6a
Explanatory note

Thrombectomy is suitable for 10% of strokes [Ref. 6] but very few eligible patients receive the treatment.

It is a specialist procedure that requires rapid recognition of eligible stroke patients, and considerable resources – a trained specialist (Interventional Neuroradiologist), special hospital facilities that are not widely available, and a support team. Trials have shown more work is needed to understand who can benefit and how long after they have a large artery stroke (from workshop discussions)

There are some ongoing trials examining widened indications for thrombectomy that may partially address this question. However, evidence is needed to effectively implement and widen access to the procedure that can dramatically reduce disability caused by stroke.

Ref 6: European Stroke Journal, Estimating the number of UK stroke patients eligible for endovascular thrombectomy, http://journals.sagepub.com/doi/abs/10.1177/2396987317733343
Evidence

No evidence identified 
Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples

Why can't you have thrombectomy at certain times/places? ~ How can we improve access to thrombectomy? ~ How can we support the greater availability of thrombectomy at an early stage for people who have had a stroke? How can training be given to help more specialists to be able to perform this operation? ~ How can we improve access to thrombectomy? ~ How can we improve our rates of mechanical thrombectomy compared to our European neighbours? How can we change our behaviour to do more computed tomographic angiography (CTA)? ~ Will more Trusts become 24h thrombectomy services?
Submitted by Stroke Survivor x 2, Health/Social Care Professional x 5, Not Stated x 2, Carer x 1 
PSP information
PSP unique ID 0106
PSP name Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 30th April 2021