Writing in the Lancet, Professor Alastair Buchan, who is both a medical doctor and a researcher, Dr Brad Sutherland and Hasneen Karbalai point out that stroke is the leading cause of disability in the UK, and the fifth leading cause of death. It costs the UK economy more than £7 billion each year.
Even so, there is only one approved NHS treatment: Thrombolysis (dissolving blood clots) using recombinant tissue-type plasminogen activator (rtPA) delivered through a drip. As part of the £60 million National Stroke Strategy, access to rtPA has been improved, benefiting tens of thousands of people each year.
Professor Alastair Buchan said: ‘This thrombolysis treatment only works in patients within four and a half hours of the stroke starting. That is one of the factors that means that for every 100 people who suffer a stroke, fewer than 12 receive rtPA.’
The team say a recent analysis of studies shows that combining rtPA with other treatments carried out in the blood vessels could reduce stroke-related disability by around 18% and stroke deaths by 4%.
Professor Buchan said: ‘As well as rtPA, there is potential for using a device like a stent-retriever that opens the blood vessel and allows the removal of clots. Alternatively, there is intra-arterial thrombolysis, in which a small catheter is inserted as close as possible to the site of the blockage to deliver clot-dissolving drugs as effectively as possible.
‘Developments in CT scanning technology mean that selecting patients who would benefit from these treatments could be done using CT scanners rather than time-consuming and expensive MRIs. These CT scanning developments might eventually enable us to use the new treatments to intervene in more than just 12 out of 100 cases.’
The authors admit that developing these additional treatments and scanning facilities could cost another £60 million. That, they say, is a small investment in reducing disabilities and deaths, which could save more than £1 billion each year.