Physicians perform mechanical thrombectomies to remove blockages in the cerebral arteries of stroke patients. Once imaging has confirmed the presence of a blockage, a delivery catheter is inserted to facilitate the introduction of a clot-retrieval device and accompanying guidewire. The interventional neuroradiologist performing the procedure then guides the device, typically a stent retriever, to the site of the clot. Once in place, the self-expanding stent is deployed and traps the clot ready for removal.
The U.K. National Institute for Health and Care Excellence (NICE) reviewed the safety and efficacy of the procedure in 2013. At that time, NICE decided the procedure had unproven efficacy and put patients at risk of serious complications. The cost watchdog’s perceptions of the risks and benefits had shifted by the time it re-reviewed (PDF) the procedure last year, largely because it had access to data from clinical trials that had published their results since 2013.
In its analysis of eight trials covering 2,423 patients, NICE associated thrombectomy with improved functional outcomes 90 days after treatment, although there was no difference in mortality across the treatment groups. With the studies also assuaging NICE’s earlier concerns about safety, the organization felt the efficacy data were strong enough to warrant recommending the procedure.
If the procedure works as hoped, patients who suffer strokes will experience better quality of life. This, in turn, should cut the cost of ongoing treatment. The NHS estimates it spends £3 billion ($3.7 billion) a year on caring for stroke patients. And that the harm caused by strokes costs the economy a further £4 billion through a mix of lost productivity, disability and informal care.
Equipping more hospitals to quickly perform thrombectomies could drive down these figures. But in the near term the rollout of the service will put a strain on the healthcare system. Today, the NHS employs approximately 90 interventional radiologists, according to The Guardian.
The NHS will need to grow that figure if it is to provide round-the-clock thrombectomies at its 24 neuroscience centers. This process will take time. The NHS plans to start phasing in the service later in 2017 and treat 1,000 more patients in the first year of the rollout. Once the service is up to speed, the NHS expects to treat 8,000 stroke patients a year with mechanical thrombectomies.