And that's why the disability caused by stroke is so acute. And then there are two main types of stroke. An ischemic stroke, which represents 85% of strokes, is caused by a blockage or a clot in the brain.

But then 15% of strokes are caused by a burst blood vessel. But both of them basically interrupt blood flow to the brain. And that's what causes damage.

There is also something that people may have heard of called mini strokes, otherwise known as TIAs or transient ischemic attacks. And that's where the symptoms of a stroke last for a very short period of time. But they're often a warning sign that a bigger stroke may be coming.

So we always say that a mini stroke is a potential medical emergency and should be treated with the same urgency as a full stroke.

Is that what causes the effects of the stroke?

However, with a blood clot, basically, the kind of blood flow is temporarily stopped. So the trick is to restart the blood flow. And that happens in two main ways with ischemic strokes.

The first is stroke patients can be given clot-busting drug it’s called thrombolysis. And that then dissolves the blood clot, then releasing blood flow back to affected area. The other treatment, which is a kind of miracle treatment, it's extraordinary, is called thrombectomy.

And that's where a blood clot is physically sucked out of the brain. And what happens is a sort of wire mesh called a stent is inserted up through the groin into the main artery of the brain, it effectively clips onto the blood clot, and then it pulls the blood out. So both have the same effect, which is that that blood flow is then kind of restored.

And the trick is to salvage as much tissue as possible. And that's why you have to act with real urgency. So we talk about time is brain.

And that's because about 2 million blood cells are kind of lost, but every second that a blood flow is interrupted. So it's really, really important that people call 999, they get to hospital quickly, they get into a brain scan quickly, because a brain scan is the only way to distinguish between the two types of stroke. And then they get the right treatment.

Something is inserted into one of the major blood vessels in your leg, usually in the groin, they steer it all the way through those blood vessels up into your brain. Wow.

And then literally within minutes of the blood clot being removed, patients are often able to regain mobility, speech, and some are discharged, you know, 24 hours later. But the reality is that, you know, it's such a shock having a stroke, it comes out of the blue, it's very, very sudden. So most people will still have some ongoing support needs.

So quite a lot of people are traumatised by having a stroke, they may have survivor guilt, they may have ongoing kind of anxiety, sometimes for some people that can tip into severe clinical depression. And for some people, they will still have residual mobility challenges, or speech and communication challenges, all of which are affected by where the clot was in the brain. So most people still need ongoing rehab.

And the shocking thing about thrombectomy is the first randomised clinical trials for thrombectomy were 20 years ago. The global evidence of thrombectomy is it's incredibly effective, but also cost effective, because it reduces the ongoing disability. But it's just not available everywhere.

So NHS England set a target in the NHS long term plan for up to 10% of stroke survivors to be getting thrombectomy by March 2028. And still, at this point in 2025, it's only just over 4% of people who are getting it. And what you see is a massive, you see massive regional disparities.

So in London, if you have a stroke, you're eligible for a thrombectomy, you've got a good chance of getting it. About 10% of people in London get it, but in other parts of the country, it can be down to 1 or 2%. So we've been running a campaign at Stroke Association calling for 24 seven access to thrombectomy and saying this is not, these regional inequalities are not acceptable.

Yes, you've got to invest upfront to make sure that the urgent and emergency care pathway and the pre-hospital pathway is really slick and quick. But then if people are getting those lifesaving treatments, they massively reduce the disability that people experience. They may not eliminate it, but they will reduce down the impact of them.

And that in turn reduces ongoing need from the NHS. It reduces the demand on social care. It means people aren't living lives in nursing or residential homes, costing their families millions of pounds.

Do you know what I mean? It's really cost effective.

You mentioned being quick. So that obviously just to this FAST acronym that I think the Stroke Association helped to develop a few years ago now. And that's really isn't it about recognising that you or somebody you've seen might be having a stroke.

Can you talk us through those letters?

Speech, they're struggling to kind of make sense or recall words or numbers. And then the T stands for time, act fast, call 999. And we really are encouraging people to still call 999, even though there's pressures on the ambulance service at the moment.

It is important that you're conveyed to hospital in an ambulance because then you're fast tracked through emergency departments. You're seen quickly by a stroke specialist team. You get the brain scan and the treatments more quickly.

And now what's happening, which is exciting, is that if people are presenting at home and the paramedics see them with FAST positive symptoms in quite a lot of parts of England, there's a video triage service that's being set up between the paramedics and the stroke consultants in the hospital. So the stroke consultant can actually see the patient, talk to them and then can make sure that they're conveyed to the right hospital and that everything is lined up. But it's not happening everywhere.

We have a great stroke helpline staffed by stroke specialists open Monday to Friday and Saturday mornings. Again, available for everyone in the UK. And then we also have local face-to-face services, but only where we're commissioned.

And that's when stroke support coordinators visit stroke survivors in hospital, go and do follow-up, provide follow-up support to take them on a recovery journey. So yeah, the main thing that we do is stroke support, but we also do campaign and influence for policy and system change. And we also fund research because research is so vital to create those kinds of clinical breakthroughs.

And is it about identifying new treatments for stroke or recovery after, or is it right across the whole pathway?

And we've got some quite exciting studies underway. There's probably one that I would kind of mention because it really captures the public imagination. We're working with the University of Birmingham who are developing a lateral flow test for stroke.

So this is testing whether through saliva you can identify somebody as having a stroke and potentially saliva can distinguish between stroke and other seizures. So we're looking at a saliva test compared to a blood test compared to urine tests. What is the best kind of most cost effective test to diagnose stroke?

So if say a lateral flow test for stroke is proven to be effective, I mean that would be a game changer because it would be simple and cost effective to administer.

Do you get people with lived experience to come on to these research committees in that kind of way and giving their experience to inform the kinds of projects you fund and how they work?

So we make sure that people with lived experience are involved in all of our research processes, in our research funding panels. We don't award research unless we're confident that the patient and public involvement angle is strong and we're going to strengthen that even further as we're about to launch early next year an updated research strategy for the Stroke Association.

We have a lot of kind of technology or medtech firms that come to us with a solution saying can you now promote this to stroke survivors and the first question we always ask is well how are stroke survivors involved in the design of this proposal and if they weren't then chances are it's not going to work.

So in terms of that kind of technology, are you aware of interesting kinds of technology which enable for example remote rehabilitation? We know that the 10-year plan for the NHS is to get people out of hospital and treated in the community and at home so it seems that that sort of tele-rehab thing is kind of an obvious way to do that. Is that sort of stuff coming in that people are using already?

So I think that trend of kind of 50-year-olds experiencing stroke is one we're watching carefully. We don't fully understand the reasons why there's such an increase, but it is a marked and significant trend.

I'm not so sure. And the problem with high blood pressure is that it's often unrecognised, it can be a silent killer. So our big message on that is you can get your blood pressure checked in a lot of places now, you don't just have to get it checked by your GP, you can get it checked by a nurse practitioner, a lot of pharmacies now offer free blood pressure checking, you can buy monitors now from Amazon that are perfectly good that only cost £20.

I'd really encourage people aged over 50 to just regularly monitor your blood pressure and if it is over the recommended limit, for goodness sake get yourself to the NHS who can formally diagnose you.

So I would just say strokes are serious, act really quickly if you spot anyone having the potential symptoms of a stroke but you know do take every effort to try and avoid them.

You will also, if you listen back through previous episodes, hear from Greg who had a brain bleed, a hemorrhagic stroke, one of the kinds that we talked about earlier on. You can learn a bit about his story by listening to that. And do check out all of the other episodes in this amazing series and thanks for listening.

Goodbye.