Doctors reverse brain bleed procedure to treat critically ill stroke patients

Doctors at Southampton’s teaching hospitals have reversed a procedure developed to stem bleeding in the brain to help them save the lives of seriously ill stroke patients.

The innovation, which involves placing a thin wire into the groin and passing it up to the skull using high definition TV images, is based on a technique originally used as an alternative to surgery for patients with ruptured brain aneurysms – fluid-filled bulges which force blood vessels to tear.

But instead of placing coils in a damaged vessel to halt blood loss, experts at Southampton General Hospital are using the device to locate blood clots and remove them from the body.

The procedure, known as intra-arterial clot retrieval, restores blood flow without the need for any surgical intervention.

Conventionally, stroke patients are treated with blood-thinning drugs through a drip within the first three hours of the onset of their symptoms, but the option is not always successful for those with blockages in large vessels or suitable for those recovering from major surgery, which makes them susceptible to internal bleeding.

“Employing a procedure developed to treat ruptured brain aneurysms, we are able to open blocked vessels that cause severe strokes – something much more common than bleeding in the brain,” said Dr John Millar, a consultant neuroradiologist at Southampton General.

“Once we locate the blocked vessel, we pass a small metal stent through a micro-catheter, immediately open it and use the same device to remove the clot.”

Dr Pam Crawford, a consultant physician and director of stroke at University Hospital Southampton NHS Foundation Trust, added: "With the treatment options for patients who suffer severe stroke limited, being able to remove the clot quickly and effectively is a major advancement and crucial to the chances of survival.”

Latest figures show the Trust’s 24/7 stroke service, launched in 2009 to rapidly treat acute or mini-stroke (transient ischaemic attack) through immediate access to a dedicated specialist team, has one of the best survival rates in the country.

Every year, each hospital receives a score based on how ill their patients are and how many survive, known as the standardised mortality ratio, with hospitals expected to meet an average of 1.0. If the number is lower it shows a better than average survival rate – and the Trust’s score is 33% lower at 0.67.

Posted on Monday 11 February 2013