- Reference Number: HEY1027/2018
- Departments: Stroke Services
- Last Updated: 9 November 2018
Leaflet for relatives
Introduction
This leaflet has been produced to give you general information about your relative’s condition and the treatment they require. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you, your relative and the doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for your relative.
What is happening?
Following review of your relative’s symptoms and any scans that may have been performed, the doctors and nurses looking after your relative feel that their symptoms may be caused by a blood clot blocking blood supply to the brain.
If left untreated this may result in a stroke. A stroke can potentially cause limb weakness, speech difficulty, visual changes and other complications. Treatment is needed to restore the blood supply to the affected area of the brain.
How can this be treated?
Treatment is administered using a drug called Alteplase, which can improve recovery and reduce the severity of any disabilities following a stroke. The administration of this drug is known as ‘thrombolysis’.
The aim of thrombolysis is to dissolve the clot and return the normal blood flow to the affected area of the brain. Thrombolysis must be given within 4.5 hours (and 3 hours if your relative is over 80 years of age) from the start of symptoms to be effective.
Alteplase cannot be given if your relative is at risk of bleeding. Therefore, a surgical procedure may be offered as an alternative to remove the clot which is called a thrombectomy.
What is thrombectomy?
A thrombectomy involves a thin plastic tube (catheter) being inserted, usually through an artery in the groin. A contrast agent (dye) is injected into the catheter to enable the blood vessels to be seen on the X-ray images. X-ray images are used to guide the catheter to the affected blood vessel in the brain. A device is moved through the catheter to the site of the blockage to remove the clot and re‑establish blood flow to the affected part of the brain.
An interventional radiologist will perform the thrombectomy and a radiographer will operate the X-ray machine. A nurse will be with your relative during the procedure to provide reassurance.
Most procedures are performed whilst your relative is awake. A local anaesthetic is used to numb the groin where the catheter would be inserted. Local anaesthetics carry fewer risks of complications than a general anaesthetic (a combination of drugs which induces a deep sleep). Neurological status monitoring is much easier when a local anaesthetic is used. There are times when a general anaesthetic may be required and this will be a decision made by the clinical team caring for your relative before or during the procedure.
Sedative drugs may be administered to your relative if they become restless. Being restless can be a symptom of a stroke and a sedative can help to settle your relative. If your relative becomes unwell during the procedure or is unable to tolerate the procedure it may be stopped and your relative will be taken to ward 110 on the 11th floor.
Occasionally, it may not be possible to retrieve the clot. This can be due to damaged or blocked blood vessels. The clinical team will discuss this with you and your relative.
What are the benefits of thrombectomy?
Removing the blood clot from the blocked vessel leads to better outcomes including greater independence and mobility. Not every patient will benefit (because some damage to the brain has already happened) but 8 out of 20 patients that undergo thrombectomy will recover with less disability than those who do not have the procedure.
What are the risks and complications of thrombectomy?
The risks include:
- The contrast agent (dye) used to see the blood vessels (arteries and veins) on X-ray images carries a small risk of an allergic reaction. In rare cases, it can permanently harm the function of the kidneys.
- Bruising/bleeding – this sometimes occurs around the groin where the catheter is inserted. Only in very rare cases is this severe enough to require surgery to repair the groin artery.
Severe complications from the procedure happen infrequently (in less than 1 in 20 patients) and the chances of a poor outcome do not increase as a result of this procedure.
Complications that are rare but more serious can include:
- Worsening of the stroke (increased limb weakness, speech difficulty, visual changes and coma)
- Perforation of an artery leading to a bleed in the brain (which can be potentially fatal)
Before we can go ahead with treatment, by law, we must explain the risks and benefits to your relative, discuss alternative treatment options, and then seek their consent.
If your relative is too unwell to be able to give informed consent, the doctors will proceed in the best interests of your relative but they will make every effort to involve you in the discussion of consent. This discussion will include your relative’s known wishes and beliefs and whether treatment is likely to be in their best interests.
Where is the thrombectomy performed?
Thrombectomy is only performed in a small number of specialist hospitals in the country, of which Hull University Teaching Hospitals NHS Trust is one.
Your relative is being transferred to the specialist unit in Hull Royal Infirmary as, after discussions between the stroke team in your hospital and the stroke team in Hull, it was decided that they might benefit from thrombectomy.
The thrombectomy procedure will be performed within Interventional Radiology Theatres (IRT) situated on the 2nd floor of the Tower Block in Hull Royal Infirmary.
How do I get to Hull Royal Infirmary and where should I go?
It will not always be possible to travel with your relative in the ambulance, so if you decide to follow your relative to Hull you may need to find your own way there. On arrival to Hull Royal Infirmary, please enter via the main entrance and go straight to Ward 110 on the 11th floor where the nursing team will be expecting you.
Parking is located on Argyle Street, which is the street next to the main hospital tower block. There is a parking charge and payment is required on leaving the car park via a machine in the main entrance or at a machine next to the car park
What will happen to my relative on arrival at Hull Royal Infirmary?
On arrival to Hull Royal Infirmary, your relative will go straight to the Interventional Radiology Theatres and be re-assessed by the medical team.
Due to the theatre environment being sterile, you will not be permitted into this area, but you will be kept informed as soon as possible regarding your relatives treatment.
If the team reviewing your relative does not feel they need a thrombectomy because their symptoms have improved, your relative may be returned back to the referring hospital.
As the benefits of thrombectomy are time dependent, the procedure might also not be performed if it cannot be completed within the necessary time frame.
How long will the thrombectomy take and where should I wait?
The thrombectomy could take anywhere from 1 to 3 hours and during this time you are welcome to stay in the visitor’s room on the stroke ward (ward 110 on the 11th floor) or alternatively visit one of the cafes in the Trust (ground floor entrance, or the restaurant on the 2nd floor). If you prefer to go home, we will contact you after the procedure. Please ensure you leave a contact telephone number with a member of the nursing team.
The doctors will speak with you once the thrombectomy has been completed and provide you with an explanation of events, the outcome of the procedure and care plan for your relative.
What to expect after thrombectomy
After the thrombectomy procedure has finished, your relative will be taken to the stroke ward (Ward 110) in Hull Royal Infirmary and cared for by the stroke team and physicians. They will be on bed rest for a couple of hours to allow the catheter entry site to begin to heal and to allow the nurses to monitor them. Some patients experience some pain in the groin from the procedure. This can be managed with pain relief. Every effort will be made to transfer your relative back to their local hospital within 24 hours.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Stroke Team / Ward on (01482) 675110 or Hull Royal Infirmary (switchboard) (01482) 875875
Information about your relative
We collect and use your relative’s information to provide them with care and treatment. As part of their care, information will be shared between members of the healthcare team, some of whom you may not meet. Your relative’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health or social organisations that provide your relative with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your relative’s doctor, or the person caring for them.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about them. For further information visit the following page: Confidential Information about You.
If your relative or their carer needs information about their health and well-being and about their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
