27 November 2018


Patients with acute ischaemic stroke should be offered a procedure to remove the blood clot up to 24 hours after the onset of symptoms.

This procedure, called a thrombectomy, should be offered alongside clot-busting drugs, if there is potential to salvage brain tissue, says NICE in draft updated guidance.

Currently, thrombectomy is only offered to people with stroke up to 12 hours after onset.

Paul Chrisp, director for the centre for guidelines at NICE, said: “New evidence shows that extending the eligibility period of thrombectomy to up to 24 hours can be very cost-effective. There is also a potential benefit for improved quality of life by reducing the level of disability people can experience as a result of a stroke.

“These recommendations could lead to an increase in referrals to centres that already provide this procedure. Centres will also need to be able to provide or have access to 24 hour care, which will have an impact on NHS resources.

“However, balanced against this are the positive effects for other aspects of stroke care, such as a decrease in demand for in-patient rehabilitation and a reduction in the need for long-term social care.”

Most strokes - sometimes referred to as a ‘brain attacks’ - happen when the blood supply to part of the brain is partially or completely blocked, killing brain cells. The other type of stroke is caused by a bleed in the brain.

Jason Kendall, Chair of the guideline committee, said: Stroke is the single biggest cause of disability in adults, the effects of which can be devastating to patients and their families. Therefore it’s imperative that we reduce the risk of disability by providing people with the most effective, up-to-date care.”

Affecting people of any age, there are more than 100,000 strokes in the UK each year.

The draft guideline, which is open for public consultation until 11 January 2019, updates NICE’s current guideline on stroke and transient ischaemic attack (TIA or ‘mini stroke’).

NHS organisations should compare their current practice with our final recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.