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British hospitals to trial new procedure for strokes by sucking up blood clots

  • ‘Hoover machine’ treatment for strokes now in UK hospitals
  • Procedure sees tube suck up blood clots to prevent damage
  • Intra-arterial thrombectomy takes just 12 minutes

By
Martyn Halle


Published:

16:00 EST, 10 May 2014

|
Updated:

17:17 EST, 10 May 2014

How it works: The new procedure could save lives

A machine that hoovers away blood clots in the brain could save thousands of stroke patients from death or serious disability.

Clots are a leading cause of stroke – when the blood supply  is cut off to part of the brain – and need to be removed as soon as possible to restore oxygen supply to cells and prevent further damage.

Usually intravenous drugs are used to break up the blockage.

Now 20 UK hospitals are trialling the new procedure, known  as intra-arterial thrombectomy, which takes just 12 minutes.

A tube is inserted into an artery via the groin, then travels to the brain to suck up the clot.

It has already saved patients such as 60-year-old Stephen Williamson, who suffered a massive stroke on the golf course two months ago. He was found to have a 2in blood clot starving his brain of oxygen.

‘His was a very dramatic recovery,’ recalls Dr Norman McConachie,  a neuro-interventional radiologist at Queen’s Medical Centre, Nottingham, who says he has never before seen such a remarkable recovery from a stroke.

‘When he got him on to the operating table he was weak and couldn’t move the left-hand side of his body.

But we pulled the clot out and almost instantly he gave us the thumbs-up with his previously paralysed hand.’

The recovery was particularly striking as the standard clot-busting drug treatment had failed to help Stephen.

About 152,000 Britons suffer a stroke each year and there are two main types – those caused by clots and those due to burst blood vessels.

For nearly two decades, doctors have been able to reach up into the brain through the groin and stop bleeding caused by burst blood vessels.

But the use of such technology  to deal with a clot is more recent, and patients with clots in large blood vessels and arteries do less well than those with smaller clots.

Now medics want to show the National Institute for Health and Care Excellence (NICE) that the ‘hoover’  is worth introducing on the NHS.

Speed is crucial as there is an urgency to removing a clot, says Dr McConachie.

‘Millions of neurons a minute are being lost while the clot  is blocking the flow of blood to the brain.

‘So every minute counts. We aim to treat patients within six hours of a stroke, but the target is three hours or even less – two if possible.’

A stroke team decides which patients qualify to have their brains ‘hoovered’ by performing a brain CT angiogram scan. The procedure works by inserting a catheter (a thin tube) up to the brain through the arterial system.

A smaller catheter is fed through it, with a probe on the end that breaks up the clot into small pieces which are then hoovered down the larger tube.

Dr McConachie says it is aimed  at removing clots from the top of the carotid artery running up from the neck, the middle cerebral artery feeding the top of the brain and the basilar artery at the back of the skull.

Need for speed: When removing a blood clot, speed is crucial in order to avoid a stroke, and the intra-arterial thrombectomy takes just 12 minutes

‘These are the ones with the largest clots that don’t respond at all well to intravenous drugs. They are often several inches thick and the drugs either don’t work or take too long to break up the clot.’ NICE accepts the technology works but claims it still doesn’t know enough about how patients fare.

‘This technology is well established in other European countries, but the UK has lagged behind and we are catching up,’ says Dr McConachie.

Hundreds of patients are now being offered the hoover, either as part of the trial or separately like Stephen. He arrived at Nottingham’s City Hospital paralysed down one side but within  48 hours found the weakness and paralysis had almost completely gone.

Dr McConachie is convinced that without the treatment, Stephen would have been left wheelchair-bound and severely disabled for the rest of his life. Instead, he was back on the golf course just weeks later.

Stephen, a father of four from Chesterfield, has suffered no long-term effects. He says: ‘I have a friend who had a stroke seven years ago and she has not got her speech back and can’t move her arms and legs.

‘Yet for all intents and purposes I am the same as I was before, and I play golf to virtually the same standard. If I hadn’t had the procedure I would have been in hospital for six months trying to get my functions back and I would have had to have carers and be in a wheelchair. It’s a miracle, really.’

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Comments (27)

what you think

The comments below have been moderated in advance.

Lord Lucan,

That would be telling, Brazil,

6 hours ago

Unfortunately it’s fashionable to knock the NHS, but this shows that in the past you got very little treatment for stokes and heart attacks, you simply died. Today we now get this new treatment along with open heart operations including by-passes, we get pacemakers and ICD’s fitted to our hearts, we even get donated hearts, none of which are cheap to do. That’s part of why the NHS costs so much more now than it once did, therefor we will inevitably have to put more in, there can’t be much argument about this fact That said; it’s the politicians as usual who interfered with a system that was working and and installed batteries of admin workers and financial consultant managers on ridiculously high wages and pensions not forgetting golden handshakes when they eventually were asked to consider their position, for failing in the extreme by cocking everything up. My point actually is be careful what you wish for, because the NHS is a Godsend and cheap compared to costly privatized bills.

Maurice Whiteman,

Bolton, United Kingdom,

6 hours ago

This has got to be as risky as hell imagine the catheter bursting the wrong artery or vein, you could end up like a vegetable in a wheel chair .

Old Chap,

Caribbean, Grenada,

3 hours ago

Or you die?

ThisIsIt,

London,

1 hour ago

That happened to my mother. She is now a vegetable in a wheelchair. Consent was not sought prior to the deployment of the device and a major lawsuit in Ireland is now pending. We have also identified through investigations, a link between the device manufacturer and the consultant who ordered the operation. Ours is quite possibly one of the first lawsuits arising from these lethal devices. I suspect that our family is not alone and there will be more.

teenborg,

London, United Kingdom,

7 hours ago

Isn’t this a bit obvious?

Someone,

Somewhere In The, United Kingdom,

7 hours ago

Anything to make the lives of patients better in the long term.

Penny01,

Cardiff, United Kingdom,

7 hours ago

This Aspiration Technique has indeed been used for a long time but the new devices now make it significantly more effective. This is now the technique of choice in Europe the UK. The UK Trial is to randomise stroke patients to the relatively new procedure of thrombectomy versus the standard treatment of clot busting drugs. Similar Trials exist in US, France, Holland.

ThisIsIt,

London,

7 hours ago

My mother in Ireland suffered serious personal injuries as a result of one of these devices being used on her without her consent. These devices and the thrombectomy procedure remain experimental and the public should be on high alert.

ExMilitaryUKTaxPayer,

Anywhere other than the UK, Afghanistan,

7 hours ago

I had a blood clot vacuumed out of my brain during brain surgery. I was back at work in Afghanistan 8 months later after beating blindness, and learning how to walk, read, type and use a knife and fork again. Brilliant technology.

Freddy,

San Diego,

8 hours ago

The U.S. has had these types of devices for about a decade. The one that is pictured is a Merci Coil Retriever which the neurointerventional radiologist tries to “corkscrew” the clot in one piece and gentle retract the clot down to the suction catheter. There are better ones in use now, like the Trevo and Solitare devices which do 2 things (1) it pieces the clot with a small catheter to allow some blood flow to shunt through the clot (even better if tPA had been given already) and reperfuses the distal vascular territories and then (2) a chicken-wire mesh springs out to “emesh” the clot so as to grab ahold of it better when you pull it out. The recent large studies looking at benefit endpoints of tPA alone vs tPA with device showed no major differences but they did not really use the newer devices or use them sooner which is the next step of investigation. Otherwise, these work great for people who can’t take tPA or are outside that time window. These have saved my patients.

John,

Wales, United Kingdom,

8 hours ago

Why is NICE prevaricating over this? The price of an operation as opposed to in Dr McConachie words “without the treatment, Stephen would have been left wheelchair-bound and severely disabled for the rest of his life. Instead, he was back on the golf course just weeks later”. Could it be the initial price of the operation against the long term costs if the procedure doesn’t work. Perhaps someone should produce a report for NICE based on the well established practice in the other European countries

ThisIsIt,

London,

1 hour ago

This is NOT a well established practice. It remains experimental and the manner in which the devices were authorised for sale on both the European and American markets is highly questionable.

maureen roberts,

perth, Australia,

8 hours ago

Great news, but why is the UK always lagging behind other European countries in technology that could save lives?.

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