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Clinical Lead for the HSE National Stroke Programme and Consultant Stroke Physician Prof Joe Harbison told the Medical Independent (MI) that current services are “very stretched” and placing a “huge burden” on those working in the area.
“It is not really resourced and we need to get to a level where it’s sustainable,” he told MI.
Around 180 thrombectomies were performed in Ireland last year — 150 in Beaumont Hospital, Dublin and 30 in Cork University Hospital (CUH), said Prof Harbison.
The service in Cork is being run “opportunistically”, according to Prof Harbison, and it cannot operate full-time as there is a requirement for another interventional neuroradiologist.
The neurointerventional suite is staffed three-and-a-half days a week in CUH, MI understands.
There are currently four interventional neuroradiologists in Beaumont and two in Cork.
Prof Harbison said he is unsure when funding for another post in Cork will become available, but stressed that the HSE is keen to progress the post.
About 600 people a year are thrombolysed and about 40-to-50 per cent of those are eligible for thrombectomy. Prof Harbison said these figures would indicate the need for two centres providing thrombectomy.
However, Ireland may get to the level where a third centre, preferably in Galway, and a fourth centre in Dublin are required due to the projected 5 per cent increase in stroke per annum over the next 20 years, added Prof Harbison.
A recent Health Technology Assessment (HTA) by HIQA on the establishment of a national emergency service for next-generation stroke therapy termed the current service “ad-hoc”.
It recommended a mechanical thrombectomy service in two sites, Cork and Dublin, and noted that thrombectomy in conjunction with current standard medical care is “significantly more likely to result in patients who have had a stroke regaining functional independence”.
The HTA found that each procedure costs €14,000. If 268 patients were treated per year, the service would cost €7.2 million, comprising €3.3 million in the first year and annual running costs of €0.8 to €1.2 million.
“If that was a drug it would make it automatically adopted by the HSE but not for interventions,” commented Prof Harbison.