When a stroke occurs, the longer the patient goes without treatment, the more brain injury he or she may suffer—so getting immediate medical attention is essential. Even with speedy treatment, however, stroke patients haven’t always experienced smooth and complete recoveries. In the past couple of years, though, a breakthrough in stroke treatment has been helping patients recover more quickly, and often with little or no lasting damage.
In June 2017, Albemarle County resident Nancy Savarie suffered a stroke. Shortly after finishing dinner, Nancy walked into her living room to turn on a light, and suddenly collapsed. “I wasn’t able to speak or to move,” she recalls.
Her husband, Roger, heard her fall and knew immediately that something was very wrong. “She had no motor control at all,” he remembers. “She was catatonic, rigid.” A retired dentist with some medical background, Roger recognized the signs of stroke and immediately called 911.
Nancy, 82, a retired tour guide and teacher, credits her husband’s quick thinking with saving her life. “He knew the fact that I couldn’t scream or yell meant something was wrong,” she says. “They took me right to the stroke unit and performed a CT scan and saw the clot in my brain. The doctor was already dressed and ready by the time I was prepped.”
A Revolution in Stroke Treatment
Just a few years ago, some patients like Nancy would have received a “clot-busting” intravenous medication known as tissue plasminogen activator (tPA), which at the time was the gold standard for stroke treatment. While Nancy did receive tPA to help alleviate the effects of the stroke, her clot also was removed physically via mechanical thrombectomy, an innovative procedure that has shown to result in better outcomes for certain stroke patients, according to five independent studies published in 2015.
“After those studies were published, the standard of care changed almost overnight,” says Sentara Martha Jefferson neurointerventional radiologist John R. Gaughen, MD. “Many patients aren’t even eligible for tPA for a variety of medical reasons, such as prior bleeding problems or the use of blood thinners. Plus, tPA must be given within a few hours of the onset of symptoms, and it’s not as effective on larger clots.”
Dr. Gaughen notes that for every 100 emergency stroke patients, only about five actually receive tPA, and on average only one will get better because of the medication. The adoption of mechanical thrombectomy has increased the number of patients who are treated successfully, as patients treated with mechanical thrombectomy are approximately two times more likely to return to independent function than those treated with tPA.
During the procedure, a catheter is placed into an artery in the groin and guided via X-ray imaging up through the neck to the clot causing the stroke. The clot is then removed with a stent retriever or an aspiration catheter. The procedure is a lot like cardiac catheterization for the heart.
While Nancy was awake for her mechanical thrombectomy, she doesn’t recall much about it, other than feeling comforted by the calming presence of the Sentara Martha Jefferson stroke team. “In spite of the situation, I wasn’t scared or wondering if I’d ever speak again,” she says. “Their reassurances really kept me at ease during the procedure.”
A Quick Recovery
Nancy’s recovery following the procedure was so fast that she even had the presence of mind to email her golf pro from the Intensive Care Unit and let him know she wouldn’t be able to make her tee time the following day. Just 48 hours after her stroke, Nancy returned home and was able to resume her normal activities, including twice-weekly golf outings.
“Her case is remarkable,” says Dr. Gaughen. “It’s not typical, but with this procedure we’re seeing more frequently—no matter how bad a clot is—that we can keep many patients from having any lasting symptoms.”
Another patient Dr. Gaughen treated went home just one day after her stroke, with no side effects whatsoever. “The ideal outcome for very sick patients who come into the hospital is that we treat them as quickly as possible, their symptoms return to normal, and they resume their lives,” he says.
Nancy, who has two children and six grandchildren, has few, if any, ill effects from her stroke, other than a bit of stress from wondering about what could have happened, had she not received the proper treatment.
According to Dr. Gaughen, as recently as three or four years ago, when mechanical thrombectomy wasn’t widely in use, stroke patients like Nancy would have had some degree of disability and a prolonged recovery. Now those who have their clots physically removed are twice as likely to return to functional independence, he says.
Time is Brain
No matter which treatment a stroke patient receives, time is of the essence. As Dr. Gaughen likes to say: “time is brain,” since stroke typically kills about 2 million brain cells per minute. To help ensure that patients receive the quickest possible treatment, Sentara Martha Jefferson works with area first responders to help them identify stroke patients and alert the hospital right away. And according to Dr. Gaughen, it’s crucial for everyone in the community to know the signs of stroke. “The fact that Roger was able to recognize Nancy’s stroke so quickly made a huge difference in the success of her recovery,” he says.
Once hospital staff is alerted about an incoming stroke patient, they can swing into action quickly and be ready the moment the patient comes through the emergency room door. After the patient arrives, he or she will undergo brain imaging scans and receive the appropriate intravenous lines, while the operating room team prepares for the mechanical thrombectomy procedure—all to ensure that there is no time lost due to inefficiency.
As an added benefit for Sentara Martha Jefferson patients, the hospital installed a helipad in 2016 that reduces the time required to transport many critically ill patients, including those from Sentara RMH. From the helipad, stroke and heart patients are transported immediately to procedural areas, bypassing the Emergency Department altogether.
Doctors still don’t know what caused Nancy’s stroke. Although the causes of about 25 percent of strokes go unsolved, the majority of strokes are caused by cardiac arrhythmias like atrial fibrillation, high blood pressure, high cholesterol, diabetes and smoking. Doctors are currently monitoring Nancy’s heart with a small implanted device to see if she has atrial fibrillation and determine if any additional measures should be taken. “It would be good to know what caused my stroke, but I may never know,” she says, noting that she’s thankful for the care she received at Sentara Martha Jefferson.
“The emergency medical technicians were very efficient and got me to the hospital quickly,” says Nancy. “Then Dr. Gaughen and all the wonderful caregivers at Sentara Martha Jefferson took such good care of me and got me back to my normal life in just a couple of days. I couldn’t be happier.”
How Can You Help Prevent Stroke?
• Control blood pressure and cholesterol
• Manage diabetes symptoms
• Exercise daily
• Control your stress levels
Recognizing Stroke Symptoms—F.A.S.T.
Think and act F.A.S.T. by following these guidelines:
F = Face
Ask the person to smile. Does one side of the face droop?
A = Arm
Ask the person to raise both arms. Does one arm drift downward?
S = Speech
Ask the person to repeat a simple phrase. Does their speech sound slurred or strange?
T = Time
If you observe any of these signs, call 911 immediately.
Meet the Doctor
Neurointerventional radiologist John R. Gaughen, MD, says he considers himself a “plumber.” Rather than fixing sinks, however, Dr. Gaughen uses the latest techniques to treat patients with life-threatening conditions of the blood vessels, such as stroke and aneurysm. He is thankful to work at Sentara, where he performs procedures in a new state-of-the-art facility, and gives much of the credit to the team of caregivers who evaluate his critically ill patients.
Dr. Gaughen joined Sentara Martha Jefferson Hospital in October 2015 and the Sentara RMH medical staff in September 2016. An avid Wahoo fan, Dr. Gaughen enjoys attending U.Va. football and basketball games.