The contractions came for Claire Glynn in the middle of the night – but so did another health emergency.
Staggering out of bed with her second child clearly on the way, she felt she was not “acting normally”.
“I was disoriented, not properly mobile. I kept falling down, I couldn’t lift my hand or open the drawers. In the mirror, I thought I looked funny. It felt like a part of my brain wasn’t working.”
Although she had no idea what was happening, and therefore felt no concern, this observation about her condition proved remarkably accurate. Rushed to the National Maternity Hospital by her husband, she gave birth safely to her son Eli the following morning, yet this was only the start of her drama.
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“I could hear the nurses saying ‘oh my God’ and ‘that’s not right’, but still I didn’t know what was worrying them.” In the depths of her confusion, Glynn didn’t know she had suffered a stroke. She needed treatment urgently if she was to avoid the worst.
Every year about 7,500 Irish people have a stroke – when a blood vessel carrying oxygen to the brain clots or bursts. About 2,000 die. Many others are left with serious disability. Yet many strokes are treatable and if the right actions are taken quickly, a patient may not have any long-term effects.
In Glynn’s case, nurses in the NMH recognised the seriousness of her symptoms. Leaving her baby in their arms, she was put in an ambulance bound for nearby St Vincent’s Hospital.
Many hospitals can treat patients with clot-busting drugs but these usually do not work for the biggest clots and the most serious strokes, and there can be side effects. More specialised treatment may be needed.
“The ambulance driver made a call,”says Glynn. “Rather than going to St Vincent’s, and then being referred on to Beaumont Hospital, we headed straight to Beaumont. I feel so incredibly lucky he made that decision.”
Beaumont is home to a national thrombectomy service staffed by medics skilled in the non-invasive removal of clots from the brains of stroke patients. The service (and a second centre in Cork University Hospital) is one of the unsung success stories of the health service. Having started small in 2010, it started to grow five years later after US trials conclusively proved how effective the procedure is. This year, the service is on course to treat more than 500 patients – 40 per cent more than in 2022.
“Thrombectomy is one of the most efficacious treatments in medicine,” says Dr Matt Crockett, consultant interventional neuroradiologist. “For every two to three patients who receive it after suffering a stroke, one bad outcome will be averted – far outstripping the performance of coronary stenting, for example.”
“You get people who are hemiplegic with a stroke – completely paralysed on one side of the body, and unable to speak – and while they’re still on the operating table, they can almost immediately recover once you’ve unblocked a blood vessel in the brain.”
However, these near miracles can be achieved only if patients are given the treatment in time. “Time is brain” is the phrase commonly used by doctors to describe the challenge of getting stroke patients the treatment they need as quickly as possible. “Every couple of minutes, you’re losing something like 2 million neurons due to to the blockage. The faster people are brought to us, the better the outcome,” Crockett says.
This requires faster recognition of the symptoms of stroke in the community and faster referrals to Beaumont or Cork from the smaller hospitals where many patients end up first. Greater awareness among the general public along with improved hospital pathways for stroke patients have significantly increased the number of procedures being performed.
Thrombectomies are performed by highly trained specialists called interventional neuroradiologists, who access an artery in the leg or arm and then direct a tube called a catheter to the brain under X-ray guidance. “We can then use this catheter to physically suck out the blood clot that is lodged in the artery or use special stent-like devices to pull out the clot,” Crockett says. “The procedure can last anything from five minutes to several hours depending on the configuration of the blood vessels and the composition of the blood clot and can be straightforward or very challenging.”
Around 15-18 per cent of patients suffering a stroke are potential candidates for a thrombectomy if they can get to a specialist centre in time. This includes many of the most serious cases. The quicker the procedure is performed, the better the chance of a good outcome, however every patient is different. “People have different plumbing in the brain,” Crockett says. “Some can last up to 24 hours and more with a blockage and still have a good outcome when you take it out. Others only last a few hours when part of the brain is starved of oxygen – it’s just the luck of the draw.”
Glynn says her memories of being treated are “all a blur”. On arrival at Beaumont, she was met by the specialist team and whisked off for her procedure. Her clot was successfully removed, she was transferred to the acute stroke ward and soon after she was walking and talking again normally. Three days later, she was discharged and reunited with Eli, who will be two in September. “I feel so fortunate that everything fell into place, and that I got the right treatment at the right time, in the right place.”
“There’s no thrombectomy service in Wales or Scotland,” Crockett says, “and only a handful of 24/7 centres in all of England with much of the population not covered.”
“It’s remarkable really, how much better the service here is than in the UK. It’s been a huge success story, even with the strain the increased numbers are putting on us.”
Most stroke victims are in the older age groups but Crockett says his team deal with a “significant number” of younger patients.
Deirdre Farrell’s son Cian was in the schoolyard when he collapsed one morning. The school acted fast by calling an ambulance, which took him to Tallaght Hospital. “He had no power on his left-hand side and no speech, so they administered clot-busting drugs,” Farrell says.
The decision was made to send the teenager on to Beaumont, with three members of the medical team from Tallaght accompanying him in the ambulance. By 11 o’clock, he had arrived in Beaumont, where he was met by the thrombectomy team. Whisked off to theatre, he was given the procedure under local anaesthetic. “By lunchtime, he was able to talk to me from his bed, and he had full movement. It was a miracle,” Farrell says. “While he had fatigue afterwards, he was able to attend a match two weeks on and go to McDonald’s with his friends.”
Farrell has since written to Minister for Health Stephen Donnelly and HSE bosses pleading for more resources for the service. “As a family, we are infinitely grateful for what was done for Cian. The five doctors who run this service are devoting their lives to it. The burden on them must be huge.”
Crockett says his team aims to treat more patients and faster, but this will take significant investment and probably a reconfiguration of services. Although Ireland is punching above its weight internationally for the number of procedures performed, significant numbers of patients are not being captured by the current system.
“Around 9 per cent of stroke patients get a thrombectomy in Ireland. The number of patients treated is increasing year on year and rising far more rapidly in the last nine months. This recent rise in numbers is really encouraging, and a testament to the hard work of staff. It has however significantly strained the system.
“With improving technology and devices, we are able to perform procedures in smaller vessels offering hope to patients who would not previously have been eligible. Recent trials have also opened up the procedure to patients with larger strokes at presentation.”
He says he is confident the HSE will recognise the need for significant investment. “Thrombectomy is not only hugely beneficial to individual patients, saving them from death or a lifetime of disability, but it is also results in a significant reduction in rehabilitation and nursing home costs in the medium to long term.”
