Inside London's largest stroke unit

Last year King’s Stroke Service saw 843 stroke admissions, and with number expected to rise how is the team working to improve stroke care? Maria Fitzpatrick, Lead Consultant Nurse at King’s College Hospital NHS Foundation Trust, comments.  

Did you know there are more than 100,000 strokes in the UK each year? That’s around one stroke every five minutes.

A stroke happens when the blood supply to part of your brain is cut off, causing your brain cells to become damaged or die, due to lack of oxygen and nutrients.

This kind of damage can cause different symptoms, depending on which part of the brain is affected. These can include difficulty speaking, moving and thinking. A stroke can cause catastrophic, permanent damage which means it is vital to call emergency services as soon as you recognise any of these signs. The quicker you seek medical attention the better your recovery outcome.

There are three types of stroke:

• ischaemic strokes happen when an artery that supplies blood to your brain becomes blocked by a blood clot
• haemorrhagic strokes happen when a blood vessel ruptures causing a bleed inside the brain. This affects all the surrounding brain cells causing them to die
• mini-strokes, or transient ischaemic attacks (TIAs), happen when there is a brief reduction in blood supply to part of the brain causing symptoms, such as temporary speech loss. A single occurrence doesn’t cause permanent damage to your brain and the symptoms usually pass within 24 hours.

The King’s Stroke Service at King’s College Hospital NHS Foundation Trust is the only multi-site Hyper Acute Stroke Unit (HASU) service in London operating two HASU and two Acute Stroke Units.

A HASU is where stroke services have been centralised and organised into concentrated sites creating a large centre of excellence operating 24/7 with the best equipment and clinicians under one roof.

With two of the eight London HASU's, the King’s Stroke Service is the largest in London, covering the entire south-east of the capital.

Between April 2017-March 2018 our stroke team at King’s College Hospital saw 843 stroke admissions, and with numbers expected to rise we are dedicated to finding new ways to improve the care we offer to patients.

Speeding up stroke research to improve care

We are committed to delivering high-quality research and are working closely with the King’s College Hospital Stroke Research Team to support an expanding and diverse portfolio of studies currently in set-up. We are involved in a number of hyperacute studies including Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST-2) or the recently opened Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST) for patients waking up with a stroke.

Both ATTEST-2 and TWIST are aimed at improving how we treat patients with ischaemic strokes, which account for about 85% of all strokes.

In the first few hours after the onset of an ischaemic stroke, giving the patient ‘clot busting’ drug treatment, also known as thrombolysis, greatly improves their chances of a good recovery outcome. The current clot busting treatment in use is called alteplase. ATTEST 2 aims to test a new, cheaper drug called tenecteplase to establish whether it is a better drug than alteplase for use in thrombolysis.

But about one-fifth of strokes occur when someone is asleep.

In this instance the person wakes up with symptoms. Because it’s not known what time the stroke took place these patients are not offered clot-busting treatment because it’s not known whether the treatment would be effective. The TWIST trial is testing if tenecteplase is effective even when administered outside the 4.5-hour treatment limit.

By being a part of international trials such as ATTEST-2 and TWIST we’re driving stroke research forwards so that we can provide the best possible care to patients and ultimately improve their health outcomes.

For more information about research studies currently open at King's College Hospital, or to get involved, please contact the Lead Stroke Research Coordinator, Aga Kieliszkowska at a.kieliszkowska@nhs.net. 

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