Each year in New Zealand, over 9000 people will suffer a stroke. Using the Endovascular Clot Retrieval method, many of these people could return home unharmed provided they reach medical attention quickly. Around six hours following a stroke, brain tissue dies off and damage becomes irreversible, so fast response is essential.
In 2008, the Neurological Foundation established the Chair of Clinical Neurology to bridge the gap between neuroscience and neurology. The theory behind this strategy was that patient outcomes would improve if researchers could work alongside clinicians. Clinical Chair, Professor Alan Barber, has proven the theory correct, bridging the gap between universities and hospitals and leading the roll out of clot retrieval in New Zealand, with stroke units performing the procedure now set up in Wellington and Christchurch. Today, almost every New Zealander is within a helicopter ride of this life saving procedure.
“When the Chair of Clinical Neurology was set up, there was no acute treatment for stroke survivors, just a general ‘one size fits all’ rehabilitation programme with physio and language therapy,” says Professor Barber.
The professor’s first initiative was the appointment of a stroke nurse specialist. As a team, he and the nurse would visit all newly admitted stroke patients. The next step was to establish a stroke unit within the neurology ward. It was only four beds at first, but it was a beginning.
An early research focus for Professor Barber and his team was EPITHET, which captured and evaluated the effects of administering clot busting drugs shortly after stroke, an action known as ‘thrombolysis’. As a direct result of this trial, the clot busting drug alteplase became Auckland Hospital’s first-ever acute stroke treatment.
“Currently we’re thrombolying around 10% percent of stroke cases in New Zealand. In some centres they’re managing to thrombolyse up to 20% of stroke patients. About a third of people are going to do better than if they hadn’t had the drug. A few times a year, I see a miraculous response.”
Clot retrieval (thrombectomy) was the next revolutionary acute treatment introduced at Auckland Hospital. The Neurology and Radiology Departments, in conjunction with the Departments of Critical Care Medicine (DCCM) and Anaesthesia, developed a protocol for the use of clot retrieval in 2011.
“Thrombectomy used to be science fiction. Now we are routinely going in and pulling out clots. One in every five people who receive the treatment will return home as healthy as they were before the stroke occurred.”
Professor Barber says that none of these achievements would have been possible without the ongoing support of the Neurological Foundation, which last year committed $2.2 million to not only fund the Chair of Clinical Neurology role for another five years, but also to take on a new research fellow. This both provides support to the Chair, as well as begins the training of the next generation of neurologists and neuroscientsists.
“Thanks to the Neurological Foundation and their loyal supporters, we have created an environment where neurological researchers can gather data from real-life clinical situations every day.”
A Real Life Example – Patient experience
On October 25, 2018, 86-year-old Tom (Thomas) Curham suffered a stroke and was rushed to the Auckland Hospital where he received a clot retrieval procedure. His wife, Mary Barry Curham, didn’t know that when she agreed to the procedure, she had just agreed to Tom receiving a ground-breaking technique that Neurological Foundation Chair of Clinical Neurology Professor Alan Barber has been perfecting for the last 11 years, which ultimately saved Tom’s life.
While Tom was out for a walk on that October day with carer Carla, he began to feel dizzy and unwell. Shortly after, a retired New Zealand Army medic was driving by on his motorcycle and told Carla to immediately call an ambulance as he recognized Tom’s symptoms as a stroke. Tom and Carla were rushed to Auckland Hospital and met by Tom’s wife Mary. “When the surgeon was there with Tom, myself and my two friends, he said ‘Tom, blink’ and Tom couldn’t blink. The surgeon then asked Tom to say his name and he couldn’t say his name,” she said. “The surgeon looked at him closely and this slide was on one side of his face.” Mary remembered that this was one of the indications of a stroke.
“ didn’t know about the procedure, the first I knew about it was when I was standing in the reception area of the ambulance bay. ‘Time is of the essence’ [the surgeon told me], ‘and I need to have your permission to do this procedure.’ Mary remembers right after she said “yes, go!” everyone started to move quickly. “The doctor was running with the bed” and after what seemed like a very short period of time, 30-40 minutes, Tom was being wheeled back to the ward. “We were told the unbelievable – that the procedure had been a complete success. One could sense the pleasure of the staff!”
Mary and Tom aren’t strangers to stroke. Their granddaughter who lives in London suffered a stroke when she was 7 years old. Although this procedure wasn’t available in London at that time, Mary hopes that people will read her story and know that “stroke can happen at any age, to anyone.”
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