Hiqa backs stroke therapy treatment

The health watchdog has recommended establishing a national emergency service providing next generation stroke therapy which has been shown to help some patients regain greater functional independence.

The treatment would be provided at two hospital sites — Cork University Hospital and Beaumont Hospital in Dublin — and would be in addition to thrombolysis (clot-busting) treatment, the standard medical care for stroke.

Máirín Ryan, HIQA’s director of technology assessment, said the treatment, known as endovascular treatment with mechanical thrombectomy, could only be conducted in hospitals that provide neurosurgery and neuro-critical care, as is the case in Cork and Beaumont.

The procedure involves using tiny devices to physically retrieve clots from the brain. It needs to be carried out within six to 12 hours of onset of stroke symptoms.

For this reason, Dr Ryan said it is essential patients are dealt with “very efficiently” on arrival at hospital with suspected stroke, including rapid access to a CT scan, followed by thrombolysis, followed by transfer to Cork or Dublin if suitable for mechanical throm- bectomy.

However, rapid access to diagnostics is not always as fast or effective as it needs to be, and there is regional variation, Dr Ryan said.

These variations need to be addressed to ensure equitable access to and benefit from mechanical thrombectomy, she said. There are also significant organisational and resource implications for the National Ambulance Service to ensure timely transfer of patients to national treatment centres and to repatriate them to their local service post-procedure.

HIQA’s assessment of mechanical thrombectomy is based on doing 268 procedures a year in carefully selected patients.

An additional 57 patients are predicted to regain functional independence at 90 days after a stroke, with almost 60% regaining functional independence compared with fewer than 40% without the procedure.

Dr Ryan said an equitable, high quality and cost- effective national service can only be provided if the procedure is offered in a small number of adequately resourced centres, sited to maximise patient access and workforce expertise.

The findings have been presented to Health Minister Simon Harris and the HSE. The five-year budget impact of a national emergency mechanical thrombectomy service compared to no service is estimated by HIQA at €7.2m based on treating 268 patients each year.

Acute ischaemic stroke occurs when there is a sudden loss of blood flow to an area of the brain due to an obstruction, usually a clot. Each year an estimated 10,000 people have a stroke-related event and an estimated 2,000 people die as a result of stroke.

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