Stroke treatment access at CUH to increase

The number of patients able to access a treatment shown to cure stroke could increase fourfold at Cork University Hospital (CUH) when it extends the hours the service is available from next July.

Currently, thrombectomy, where the clot that caused the stroke is removed by mechanical means, is only available Monday to Friday, 8am to 8pm, at CUH.

Consultant geriatrician Liam Healy told attendees at yesterday’s Munster Stroke Network annual study day in Cork that an around-the-clock service will be available at CUH from July.

Dr Healy said of approximately 500 stroke patients at CUH last year, about 52 underwent thrombectomy. 

Once the service moves to 24/7, that was likely to increase to 150-200. 

Eligible patients will have suffered acute ischemic stroke, caused by a major blood clot in the brain. 

It’s estimated that about 15% of stroke patients have that type of stroke.

The outcomes for patients who undergo thrombectomy can be dramatic, to the point of cure.

“About one in every two had a significant reduction in disability,” said Dr Healy.

And stroke is effectively cured in about one in four. These patients can leave hospital after three to four days, where previously they would have been hospitalised for three to four months.

During a thrombectomy a catheter is guided, using X-ray, from the groin to the blood vessel in the head where doctors retrieve and remove the clot.

But while thrombectomy is “hugely powerful and hugely cost effective” other elements of care for stroke patients are lagging behind, the conference heard.

Prof Rónán Collins, clinical lead for the National Stroke Programme, said Ireland currently has 225 stroke unit beds, but needs double that amount.

Dr Healy said there are currently 12 stroke unit beds in CUH, but 25 are needed. 

They also need to boost the Early Supported Discharge (ESD) team, which is significantly understaffed. 

Prof Collins said there are currently just six ESD teams nationally, but the aim is to have 15 by 2021.

Prof Áine Carroll, professor of Health Integration and Improvement at University College Dublin and former HSE head of clinical strategy and programmes, lamented the lack of rehabilitation services for stroke patients.

She said access to rehab is a basic human right as per Article 26 of the UN Convention on the Rights of Persons with Disabilities.

“Our patients are not interested in longevity. They are interested in independence and quality of life. To me, that equals rehab,” said Prof Carroll.

“I feel once they leave the hospital they are falling off a cliff,” she said.

Dr Healy said rehabilitation services are “quite chaotic” and tend to be age-based rather than needs-based.

Stroke patients over the age of 65 receive good support services at St Finbarr’s Hospital in Cork “but for the under 65s, there’s not a whole lot”, said Dr Healy.

Prof Des O’Neill, consultant geriatrician and programme director of the National Office for Traffic Medicine, delivered a presentation on Driving After a Stroke. 

“Cognitive impairments do not, of themselves, rule you out,” he said. 

In fact, research had shown such drivers tend to exercise more prudence.

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