By Dr Simon Hart and Dr Sarah Keir, Royal College of Physicians of Edinburgh

MECHANICAL thrombectomy is a relatively quick intervention, typically taking a trained clinician around 30 minutes. It is by far the most advantageous intervention for selected patients who have had a severe stroke – and it is cost-effective, saving bed days, complex medical rehabilitation and the expense of long-term social care facilities.

The treatment can save lives or avert significant life-changing disability. The clear advantage of mechanical thrombectomy over other available treatments, including thrombolysis alone, has been revealed with strong evidence from numerous randomised clinical trials.

There was neither sufficiently effective planning nor timely implementation of this service in Scotland between 2014 and 2018. It is recognised that in the last 12 months detailed planning has now been taking place to provide this service in the future, initially in one hospital in Scotland.

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In contrast, European countries have been rapidly advancing mechanical thrombectomy services. A survey of European countries revealed rapidly increasing availability of stroke thrombectomies. In one year, 2016, Germany performed approximately 9,000, France 4,500, Spain, despite severe austerity measures within its health service, carried out 2,400.

Most European capital or major cities have a stroke mechanical thrombectomy service. Edinburgh and Scotland have none.

Initially slower to introduce mechanical thrombectomy than European healthcare services, England’s target for this year is 1,000 with a plan and proposed funding for subsequent years to increase this to 8,000 per year. Most NHS Trusts in England provide at least some access to stroke mechanical thrombectomy, even if transfer to another hospital is often required. Northern Ireland and the Republic of Ireland each have a centre actively offering this service.

People with stroke across Scotland are missing out on their best chance of recovery simply because they live north of the Border.

Leading specialists in England said that they have witnessed many patients walking out of hospital after thrombectomy but that is not the case across the whole of England, or indeed the whole of the UK.

A recent attempt to transfer a young new acute stroke patient from Edinburgh to England for mechanical thrombectomy in weekday business hours, was regrettably unsuccessful due to lack of co-ordinated air ambulance support.

In terms of solutions for Scotland, mechanical thrombectomy involves specialists skilled in neurovascular intervention in a specialised intervention suite, supported by trained radiographers, nurses and anaesthetists performing a procedure only a few hours after onset of the patient’s symptoms.

A highly coordinated multi-specialist approach is required to select and transport the patient in time. This also requires support after the procedure for a safe environment and to maximise neurological recovery. Delivering mechanical thrombectomy demands collaboration across specialties and hospitals and a 24/7 service is likely to require some innovative thinking for recruitment and training in the interventional procedure, working across traditional boundaries. Initially only radiologists performed mechanical thrombectomy.

Previously, Scotland was proud to be at the forefront of the last significant advance in the late 1990s, for a new emergency treatment for people having an ischaemic stroke – thrombolysis. In the early 2000’s pioneering thrombectomies were performed in Edinburgh.

Thrombectomy is now widely available elsewhere today, not only in Europe, but also Scandinavia, Australia and North America; most modern healthcare systems. Currently there is no service in Scotland. There remains no date set for starting this service. This inequality of provision between Scotland and other countries worldwide and even the other devolved nations across Britain, is clear. It is time that this is addressed.