Speedy collaboration results in good outcome for stroke victim

April 20, 2018 | by Edward-Elmhurst Health
Categories: Healthy Driven Heroes

Don Chasteen was watching TV in his living room when he heard a crash in the kitchen. He soon discovered his 61-year-old wife Betty had fallen to the floor.

The Elmhurst resident called on his U.S. Army medic training of years ago and began to assess Betty’s symptoms.

He says, “I asked her how she fell. She started mumbling and she couldn’t get up from her left side. I wondered if she might have a head injury because she said she’d hit her head on the dishwasher. In the back of my mind I thought this also could be a stroke. After about four minutes I called 911.

“When the EMTs arrived a few minutes later they were able to get her sitting up. They could see then that her lip was drooping down on the left side. They called the Elmhurst Hospital ER to say they were bringing in a possible stroke patient. Betty said she didn’t think she’d had a stroke.”

The ambulance arrived at the Elmhurst ER about 15 minutes after the onset of stroke symptoms. Samuel Hayward, M.D., an emergency medicine physician, noted Betty had several stroke symptoms, including “severe weakness in the left arm and left leg.”

She was rushed to the Imaging Department for a CT (computed tomography) scan to rule out a bleed in the brain. Strokes are most often caused by an obstruction, typically a blood clot, but they can also be caused by bleeding on the brain. Each stroke type requires a different treatment.

Seeing no evidence on the CT of a bleed, Dr. Hayward ordered a blood clot-busting drug called tPA. Doses of this medication are geared to the patient’s weight, a process that until recently was done in the hospital pharmacy. A new protocol allows nurses at Elmhurst Hospital to mix the tPA themselves in the ER.

Says Dr. Hayward, “This new procedure can save as much as an hour. Timing is critical with strokes. The quicker you restore blood flow to the brain, the better the chance of survival.”

The tPA was administered to Betty just 12 minutes after she arrived in the ER.

Unfortunately, the tPA was not enough to break down the rather large clot blocking Betty’s right middle cerebral artery, the biggest of the three major arteries that send fresh blood to the brain. Dr. Hayward ordered a CTA (angiography) for a more detailed view of the blood vessels in Betty’s head and neck. He then called neurointerventionalist Michael Hurley, M.D., of the Edward Neuroscience Institute, and the two agreed that transferring Betty to Edward Hospital for a clot-retrieval procedure was the best option.

About 75 minutes after arriving at Elmhurst Hospital, Betty was in an ambulance on the way to Edward where Dr. Hurley had mobilized a team for the procedure — a mechanical cerebral thrombectomy (clot removal). By the time Betty arrived at Edward, the intervention suite was set up and the staff ready.

In this X-ray guided procedure, Dr. Hurley made a tiny incision in Betty’s thigh and delicately threaded a tiny catheter (tube) through a guidewire along the approximate 3-foot journey from her leg, up through the aorta, and exiting into the carotid branch into the right side of her neck. At this point, contrast (iodine dye) was injected into the carotid artery outlining the pathway to the blocked, right middle cerebral artery.

This catheter was then used as a conduit for a thinner, softer catheter which was advanced all the way up to the edge of the obstructive clot. The third and final catheter was pushed all the way through the clot to the other side of the blockage. At this stage, there were three catheters stacked inside each other.

Next, a net-like “stent retriever” attached to a guidewire was delivered via the smallest catheter to and through the clot, expanding as it left the catheter tip and essentially “grabbing” the clot. Then, suction was applied to the larger catheter at the edge of the clot and the stent retriever was slowly pulled back, allowing the suction catheter to ingest the clot along with the stent retriever.

An injection of contrast dye through the remaining catheter showed no remaining clot and normal blood flow through the many branches of the reopened middle cerebral artery.

Says Don, “The doctor came out and showed me an image of her brain before the surgery with the clot on the right side of her head. Then he showed me a picture after the surgery and the right side looked just like the left side. By the time she got up to her room she was pretty well back to normal, except for a slight drooping of her mouth.”

They learned the blood clot probably resulted from an episode of atrial fibrillation she experienced the night before.

Says Dr. Hurley, “In atrial fibrillation, the upper chambers of the heart are just rippling instead of beating. The blood can’t flow efficiently so it pools and can form clots. Usually a mechanical clot extraction is necessary to open up a blocked vessel of this size — what we call a “large vessel occlusion” or LVO. With this type of clot, about one out of three people will die.”

Betty’s procedure was on a Sunday and she was released from the hospital on Thursday. The following Monday she was back at her detail-intense job as a buyer for a valve manufacturing company. According to her coworkers, she wasn’t missing a step.

“I feel good,” says Betty. “I just have a little weakness on my left side. I’m going to physical therapy for that.”

Dr. Hurley says Betty’s story demonstrates the importance of acting fast if you see someone with possible stroke symptoms, such as facial and arm weakness or trouble speaking. The way to remember this is through the acronym “FAST” — face, arm, speech and, importantly, time.

He says, “Just because a stroke doesn’t cause pain is no reason to roll over and think it will go away. You don’t know which people will have only two hours before serious damage occurs. Get them in quickly to give them a chance.”

In Betty’s case, quick action on the part of her husband and the EMTs, and coordinated efforts of the Edward and Elmhurst Hospital teams supported her good outcome.

Says Betty, “My husband took good care of me and I owe him a big thanks for that — and the same goes for the doctors, nurses and paramedics.”

Learn more about neuro services at Edward-Elmhurst Health.

To learn if you’re at risk for stroke, take a free, five-minute StrokeAware assessment.


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