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Poor mini-stroke care in UK

Poor mini-stroke care in UK leads to needless death Leads to 'needless death'

Thousands of people with symptoms of a mini-stroke - also called a transient ischemic attack - are missing out on life saving operations, a UK audit has found.

Those who experience the symptoms of a mini-stroke are routinely treated as a "low priority", according to the audit.

The findings have prompted surgeons to call for an urgent review of vascular services in the UK.

Mini strokes happen when a small blood clot temporarily blocks blood flow to the brain. Although the symptoms are similar to those of a stroke, they usually disappear within 24 hours. Without treatment one in five people who have a TIA will go on to have a full stroke in the following month.

Classic stroke and mini-stroke symptoms include facial or arm weakness, speech problems and blurred vision in one or both eyes.

If patients with symptoms of a mini-stoke were treated in the same way as potential heart attack patients, the report says that hundreds of lives could be saved every year.

According to the government National Stroke Strategy, people who show the classic symptoms of a mini-stroke should ideally have an operation on the neck arteries - called a carotid endarterectomy - within 48 hours to lower the risk of a severe stroke occurring.

And the National Institute for Health and Excellence (NICE) recommends it should be performed within two weeks of the person experiencing symptoms.

But the audit found that only three per cent of patients were operated on within 48 hours and approximately one third within 14 days of people experiencing symptoms.

Around 70 per cent of patients missed the two week deadline for the operation due to not recognising the symptoms, staff and equipment shortages and patients not being treated as emergency cases.

Instead, thousands of patients have to wait weeks or sometimes months for an operation that may be of no benefit by the time they receive it. If patients underwent surgery within two weeks, experts predict that around 200 strokes could be prevented for every 1,000 operations.

However, of the estimated 10,000 patients each year who might benefit from the operation, only 4,500 actually receive it in the UK.

Professor Ross Naylor, consultant vascular surgeon at Leicester Royal Infirmary and member of the UK Audit Steering Group, said: “Evidence shows that the best quality of care comes from those centres which are geared up to offer rapid access to TIA clinics which offer immediate access to imaging of the brain and its blood vessels.

"These centres can then quickly identify high risk for stroke patients, start their medical therapy and arrange for their immediate transfer to the nearest Vascular Surgery unit for urgent surgery.

"Strokes and TIAs are emergencies and must be treated as such.”

Each year in the UK, around 120,000 people have a stroke and 20 to 30 per cent die within a month. Stroke is the largest single cause of significant adult disability and nearly a million people are living with its after-effects.

The findings come from the Audit of Vascular Surgical Services and Carotid Endarterectomy, carried out by the Royal College of Physicians and the Vascular Society.

This article was published on Fri 23 July 2010

Image © James Steidl - Fotolia.com

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