December 2022 | Issue 48
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So, you want to be a principal investigator? Diederik Dippel
Stroke community intensifies efforts to tackle “unacceptable” thrombectomy access disparities A wealth of new data confirming the beneficial role mechanical thrombectomy can play in the treatment of acute ischaemic stroke came to light through the 2010s, but global healthcare systems are still fighting to make these procedures available for more patients, more of the time, and on a more universal basis. Around-the-clock services are yet to be established across the UK and, even in regions where this has been achieved, such as the USA and other parts of Europe, notable care disparities remain, with recent developments reflecting the urgent, worldwide need to rectify this.
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n October, representatives of the Stroke Association were at 10 Downing Street in London, UK to hand over an open letter encouraging Prime Minister Rishi Sunak and the British government to prioritise a 24/7 thrombectomy service for eligible patients across the country. The letter, and the benefits associated with this intervention, were backed by more than 9,000 signatures from among the stroke community—and supported by the World Stroke Organization (WSO), the British Heart Foundation and the Royal College of Radiologists, along with many other groups. Sanjeev Nayak (University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK), a consultant interventional neuroradiologist who played a leading role in establishing the first 24/7 thrombectomy service in the UK, and is now championing the Stroke Association’s attempts to make this a nationwide offering, recently spoke to NeuroNews to discuss this in more detail.
Profile Shelley Renowden
The “incredible opportunity” offered by TENECTEPLASE page 11
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Left to right: Sanjeev Nayak, Stroke Association CEO Juliet Bouverie and stroke survivor Phil Woodford
Image credit: Stroke Association
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Having submitted the aforementioned letter to 10 Downing Street on 17 October, the charity is yet to receive a response from the British government, but a subsequent parliamentary reception held at the House of Lords saw various stakeholders involved in stroke thrombectomy care meet with UK members of parliament (MPs). Nayak noted that this event was well attended, with many MPs strongly supporting the need for a 24/7 thrombectomy service throughout the UK. “The concept of a postcode lottery is no longer acceptable,” he added. “This life-changing service should be available round the clock throughout the UK. Last year, more than 6,000 patients in the UK missed out on this treatment—which meant they suffered significant physical disabilities because of severe stroke [that] could potentially have been prevented. The costs of stroke rehabilitation because of disability runs into [the] millions of pounds and this money can instead be used to fund the 24/7 stroke thrombectomy service within UK.” In its letter addressed to the UK prime minister, the Stroke Association asserts that thrombectomies can save brains, save money and, ultimately, change lives, yet provision of these procedures is “patchy”, as treatment rates vary from 80% of patients who need them in London to 0–30% in other parts of England. With National Health Service (NHS) England having missed its target of fully rolling out this treatment by 2022, and the current thrombectomy rate standing at 2.8%, the Stroke
“The concept of a postcode lottery is no longer acceptable.” Sanjeev Nayak
Brain stimulation improves COVID-19 outcomes in randomised trial IN THE RANDOMISED HDRECOVERY clinical trial, the use of high-definition transcranial direct current stimulation (HD-tDCS) has been found to be associated with a statistically significant increase in the number of ventilator-free days among critically ill COVID-19 patients. Writing in the journal Brain Stimulation, Suellen Marinho Andrade (Federal University of Paraíba, João Pessoa, Brazil) and colleagues state: “HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible potential add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxaemia.” The authors begin by noting that HD-RECOVERY was conducted to evaluate the efficacy and safety of HD-tDCS alongside respiratory rehabilitation in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) due to COVID-19. In the trial, a total of 56 critically ill patients were randomised 1:1 to active (n=28) or sham (n=28) HDtDCS plus respiratory rehabilitation for up to 10 days—or until intensive Continued on page 23
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