A forthcoming inquest in Preston is set to shine a further spotlight on inconsistencies surrounding out-of-hours stroke care.
Renewed attention is being drawn to an issue that patients, doctors, campaigners and Coroners have warned about for years: unequal access to mechanical thrombectomy treatment across the UK.
Mechanical thrombectomy is widely regarded as one of the most significant advances in stroke treatment in recent decades. Yet despite national guidance and NHS ambitions to expand access, availability continues to vary significantly depending on where a patient lives. According to a recent editorial published in Stroke & Vascular Neurology, access to thrombectomy remains an “unacceptable postcode lottery” across the UK.
For patients experiencing a severe stroke, those variations can have devastating consequences.
What is Mechanical Thrombectomy?
Mechanical thrombectomy is a specialist procedure used to remove a blood clot from an artery in the brain following an ischaemic stroke.
The treatment is primarily used for strokes caused by large vessel occlusions, which are associated with higher rates of death and long-term disability. Evidence shows that thrombectomy can significantly improve patient outcomes when delivered quickly. Reducing disability and increasing the likelihood of independence after a stroke.
Time is critical. Stroke specialists often refer to the phrase “time is brain” because brain cells begin to die within minutes of a loss of blood supply.
Why is access to Thrombectomy a national issue?
More than 100,000 people suffer a stroke in the UK each year and experts estimate that around 15,000 patients could potentially benefit from thrombectomy annually. However, only around 4.5% of UK stroke patients currently receive the procedure.
The variation between regions is striking. While London has achieved thrombectomy rates of approximately 10%, some other areas report rates as low as 1%. Wales and parts of England continue to fall behind both national ambitions and comparable European healthcare systems.
Specialists have identified several contributing factors, including:
- shortages of specialist clinicians and support staff
- limited availability of 24/7 thrombectomy services
- delays in transferring patients between hospitals
- inadequate infrastructure and funding
- regional differences in stroke pathways
What have previous inquests found?
Concerns about thrombectomy access in Lancashire were highlighted at inquests heard by Christopher Long.
Following an inquest in 2023, Christopher Long, then Area Coroner for Lancashire and Blackburn with Darwen, issued a formal Prevention of Future Deaths Report. The report recorded evidence that there was no thrombectomy provision in Lancashire after 5pm and that neighbouring NHS trusts that previously accepted patients were no longer able to do so.
The Coroner expressed concern that there was no coordinated regional arrangement to ensure access to this urgent and potentially life-saving treatment outside of normal working hours. He concluded that action was required because there was a risk that future deaths could occur if the issue was not addressed.
Following a further inquest in 2024, Christopher Long raised concerns that the national service plan for 24 hour thrombectomy services was not being delivered in Lancashire and that there was no clear plan to deliver it
Why do inquests matter?
Inquests are an important mechanism for examining deaths where concerns exist about medical treatment, healthcare systems or patient safety.
Where evidence identifies wider systemic failings, coroners have the power to issue Prevention of Future Deaths Reports, drawing attention to risks that may affect others and requiring organisations to explain how those risks will be addressed.
In the context of stroke care, these investigations can help identify whether delays in diagnosis, transfer arrangements, specialist treatment availability or service configuration contributed to a patient’s death.
Should life-saving stroke treatment dependent on where you live?
The central question raised by both leading stroke clinicians and Coroners is a simple one: should a patient’s chances of recovery depend on their postcode?
More than a decade after thrombectomy became an established treatment, experts argue that access remains inconsistent and that substantial investment is needed to deliver comprehensive 24/7 services across the country.
As attention turns to the forthcoming Preston inquest, the wider issue remains firmly in focus. Families, clinicians and patient safety campaigners will hope that continued scrutiny leads not only to answers for those affected, but also to meaningful improvements in stroke care.
Because when every minute matters, equal access to life-saving treatment should not depend on where a patient happens to live.
