New minimally invasive surgical devices called stentrievers are enabling brain surgeons to stop strokes in their tracks.
Monica Bembry, 36, was paralyzed on her right side when she arrived at Loyola University Medical Center. Neurosurgeon William W. Ashley, Jr., MD, PhD, used a stentriever to remove a blood clot that was blocking blood flow to a major part of her brain.
Once blood flow was restored, Ms. Bembry's symptoms reversed completely, and she has fully recovered. "I feel very fortunate and blessed," she said.
About 85 percent of strokes are ischemic, meaning they are caused by clots that block blood flow to the brain. The intravenous clot-busting drug tissue plasminogen activator (tPA) can restore blood flow, if it's given soon enough and if the clot is small enough. But in many patients, tPA alone is not sufficient to restore blood flow. In such cases, a stentriever can be used to remove a clot in a minimally invasive treatment known as endovascular therapy.
Five recent clinical trials have shown "in resounding fashion" that endovascular therapy in certain patients is highly beneficial, as compared to t-PA alone, according to an editorial in the New England Journal of Medicine by Anthony Furlan, MD, of University Hospitals Case Medical Center.
Stentrievers, also known as stent retrievers, work faster and are more reliable than earlier generations of mechanical catheter devices, Dr. Ashley said. "And devices are continually evolving and improving."
Ms. Bembry, a barber, was at work getting ready for her next client when she suddenly felt sleepy and couldn't move her right hand. She lost movement in her right leg and fell down. The right side of her face also was paralyzed. The owner of her barbershop called 911, and she was taken by ambulance to Loyola.
Ms. Bembry was examined by Murray Flaster, MD, PhD, a neurologist and stroke specialist. Dr. Flaster ordered a CT angiogram, which confirmed Ms. Bembry's stroke was caused by a blood clot. The clot was lodged in a T-shaped junction where the internal carotid artery splits into two branches, the middle cerebral artery and the anterior cerebral artery.
Dr. Flaster put Ms. Bembry on tPA. But he determined that the clot-busting drug alone would not be sufficient to remove the large clot. So he referred Ms. Bembry to Dr. Ashley for emergency surgery.
Dr. Ashley inserted a catheter (thin tube) in an artery in the groin and guided it through various blood vessels up to the brain. The stentriever was attached to a wire, which Dr. Ashley guided through the catheter up to the blood clot. A stentriever is a self-expanding mesh tube, similar to stents used in heart patients. When the stentriever expanded, it pushed the gelatinous blood clot against the wall of the blood vessel, immediately restoring blood flow. Dr. Ashley then used the stentriever to grab the clot and pull it out. Endovascular therapy is much less invasive than traditional open surgery, in which a portion of the skull is removed to gain access to the brain.
Not all stroke patients can benefit from endovascular therapy. The treatment has been shown to be effective only in certain arteries, and only when done within six hours of the onset of the stroke. The longer treatment is delayed, the more likely damage from the stroke will be irreversible. Thus, it's critically important to call 911 at the first signs of a stroke, Dr. Flaster said.
Dr. Flaster said the FAST rule is an easy way to recognize stroke symptoms:
F. Face. Ask the person to smile. Does one side of the face droop?
A. Arms. Ask the person to raise both arms. Does one arm drift downward?
S. Speech. Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
T. Time. If you observe any of these signs, it's time to call 9-1-1.
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