Paulette Foster loves her job at Bel Air Elementary School, but during a tense wait at Trinity Hospital – hoping for good news about her husband’s stroke, it occurred to her she might have to quit her job. “I was thinking all this crazy stuff,” she said. “This is my husband and my best friend; I’ve got to take care of him – that was my first thought.”
Paulette’s worst fears might have been realized but for a relatively new procedure launched within Trinity Health’s Interventional Radiology Department. Called mechanical thrombectomy, the procedure has revolutionized stroke care for a significant percentage of patients who experience an ischemic stroke, the most common type of stroke.
Ischemic strokes occur when a blood clot becomes lodged in a vessel in the brain or neck, depriving brain tissue of vital oxygen. Brain cells begin to die within minutes. Failure to go to the nearest emergency department at once can have disastrous consequences: stroke is the leading cause of long-term disability in the U.S. and the second leading cause of cardiovascular death after heart attack.
“About 50% of ischemic strokes involve blood clots in small vessels,” explained Barry Amos, DO, DACR, an interventional radiologist who led the effort to inaugurate Trinity’s stroke thrombectomy program. “They can cause significant symptoms but are so small, the only treatment is to administer a clot-busting medication like alteplase. However, about 50% of ischemic strokes are large-vessel strokes involving large blood clots. These can cause very severe symptoms and don’t respond as well to alteplase. These are the strokes we can now treat with mechanical thrombectomy.”
Mechanical thrombectomy is a minimally invasive procedure that uses catheter-guided technology – a staple of interventional radiology – to physically remove large-vessel blood clots in stroke patients. A thin, flexible catheter is threaded through an artery to where the blood clot is located, and the clot is extracted with suction. If the suction method isn’t successful, a retriever device is deployed that wraps around the clot and pulls it out.
“There was a group of trials that released results in 2015,” Amos noted. “The results were so striking – the trials were stopped early due to profound clinical benefit. In fact, the results overwhelmingly showed mechanical thrombectomy to be among the best medical treatments found in medical history.”
As a result of those trials, the American Heart and American Stroke associations changed their guidelines, adding thrombectomy as the standard of stroke care for patients with large-vessel occlusions who meet additional criteria such as exhibiting significant symptoms, presenting within a 24-hour time frame (preferably less), and having imaging results that show healthy brain tissue sufficient to justify the procedure.
To Paulette’s delight, her husband, Clarence Foster, met the criteria to undergo stroke thrombectomy.
Clarence, a buyer in Trinity Health’s Supply Chain Management Department, doesn’t remember much about his stroke. “I remember lying on the floor of my office and wondering why I was down there and why I couldn’t talk. I knew something had happened, but I didn’t know what.”
Most of the offices in Supply Chain Management surround the department’s reception area. It wasn’t long before Sandy Holzer, the department’s administrative assistant, heard a noise coming from Clarence’s office that didn’t sound right. She went to check and found him lying on the floor. Summoning help from her colleagues, Sandy and her co-workers sprang into action. They called 9-1-1 and helped with the crucial task of establishing as precisely as possible when Clarence’s symptoms first began – a key detail for triaging stroke patients to determine the best course of treatment.
Arriving at Trinity’s Emergency/Trauma Center, Clarence exhibited right-side paralysis and was completely aphasic (unable to speak) and unresponsive.
A head scan and subsequent angiography pointed to a large-vessel clot – the kind of stroke that is tailor made for mechanical thrombectomy. He received the clot-busting medication alteplase, then Amos performed the thrombectomy procedure. “We accessed the clot through the neck. It took two suctions, but after the second suction, the artery completely opened,” Amos said, adding, “The clots were some of the largest I’ve ever seen.”
After the procedure, Clarence was taken to the Intensive Care Unit. Paulette was joined by their daughter, Felicia, a nurse from Virginia, who was surprised at how well her dad seemed. “He couldn’t talk and appeared swollen, but we were amazed,” Felicia said. “Therapy came and had him do a lap around the ICU. I couldn’t believe it; I was like, wow!”
Clarence was transferred to a nursing floor where he continued to make rapid progress with help from speech, physical and occupational therapies. “The speech therapist was really good,” Felicia said. “She began by having him say his A-B-Cs, which was music to my ears. If she asked him a question and he said, ‘mmhmm,’ she’d say, ‘No, you need to enunciate and train your tongue to get moving.’” Within a few days Clarence was discharged home.
Shortly thereafter, Paulette decided to use the cell number that Amos had provided. “He gave me his number and said I could call him, and I did. I just wanted to say thank you. I thank God that he was there.”
The whole Foster family gives high marks to all who took care of Clarence – the nurses, inpatient therapists and other hospital staff, as well as the outpatient therapist who helped him get his strength back. Since the stroke, he has been taking daily walks and eating healthier. He’s lost about 50 pounds, and his diabetes has improved. Paulette still has her job at the school. “Everyone at the school was great, from the principal to the staff and even the kids,” she said. Clarence returned to work in April, four months after his stroke. How would he describe his outcome? “I would say excellent. I’m alive; I’m very pleased.”
Clarence’s case is no outlier. A review of performance metrics after one year of offering stroke thrombectomy shows that Trinity Health’s program lines up well with national standards. Amos anticipates even greater improvement with the move to Trinity’s new healthcare campus, where a larger Interventional Radiology suite will allow for better workflow processes and systems to improve revascularization times.
As always, the challenge is educating the public. If you suspect you or someone you know might be having a stroke, don’t wait to see if the symptoms get worse or go away. Go to the nearest emergency department at once or call 9-1-1.
“Time is brain,” Amos declared. “We’ve built a program here that can treat patients fast and effectively, but it doesn’t matter how good a job we do if people don’t act. They need to come in right away so we can do a CT. Waiting six or even three hours can diminish chances of a good outcome. Public awareness is the most important thing; that’s where it all starts.”