NEW RESEARCH showing the benefits of clot-busting treatment for people with a stroke has highlighted deficiencies in stroke services in the Republic that limit the number of Irish patients who can avail of the life-saving treatment.
The new study, published in the current issue of the New England Journal of Medicine, shows that clot-busting (thrombolysis) treatment is effective when given up to 4.5 hours after the onset of stroke symptoms.
The ECASS-3 study followed 821 patients across Europe who were given either active thrombolysis or an inactive placebo between three and 4.5 hours after stroke onset. Until now, it was thought clot-busting treatment was effective only if given within three hours of symptom onset.
Long-term disability was reduced by more than one-third in those patients given active treatment. The benefits of thrombolysis were seen in patients with all levels of disabling stroke, from mild to severe.
According to Prof Des O'Neill, chairman of the Stroke Council of the Irish Heart Foundation (IHF) and consultant geriatrician at the Adelaide, Meath and National Children's Hospital, Tallaght, this latest research "highlights the need for the urgent development of stroke units and embedded within these units the facility to give thrombolysis".
He pointed out that just one hospital in the State has a fully resourced stroke unit. "Many specialists have submitted plans to have stroke units [throughout the country] but we are concerned that, because of the worsening economic climate, these plans may be put on hold."
In April, the IHF's national audit of stroke care reported that 350-500 deaths a year could be saved if stroke unit care was introduced in the Republic. Some 10,000 people are admitted to hospital here every year with stroke as their primary diagnosis. About 30 per cent of these patients die within one year of admission, while many others are left with significant disability.
Stroke, also known as a cerebrovascular accident (CVA), occurs when the brain is starved of oxygen. In an ischaemic stroke, the blood supply to a part of the brain is cut off by a clot. A less common form (haemorrhagic stroke) occurs when blood leaks from an artery into the brain.
Thrombolysis is effective if given rapidly to people with an ischaemic stroke. It is contraindicated in patients with haemorrhagic stroke. A brain scan is required to distinguish between the two types.
However, the national stroke audit found just 4 per cent of patients here were scanned within three hours of hospital admission. It also found the proportion of people getting to hospital within two hours of a stroke is substantially lower in the Republic than in Britain, with only 5 per cent being admitted within two hours here compared with 39 per cent in the UK.
Prof Peter Kelly, consultant neurologist at Dublin's Mater Hospital, said: "This important study increases the number of patients who should receive emergency thrombolysis treatment for stroke.
"This challenges the HSE to provide safe and effective treatment for these patients as it will require reorganisation of stroke services and ringfenced funding for specialist stroke teams and acute units."