Health & Medicine

How doctors are treating strokes in even less time

Melissa Logue, who underwent a stroke procedure in January, listens as Dr. George Luh discusses her situation.
Melissa Logue, who underwent a stroke procedure in January, listens as Dr. George Luh discusses her situation. aseng@sacbee.com

When a stroke hits, every second counts.

Caused by blood clots that lodge in the brain, a stroke can be disabling, if not deadly. Nationwide, it’s the No. 5 cause of death.

Melissa Logue is one of the lucky ones. On a January afternoon, the Carmichael mother was getting her 3-year-old daughter ready for a nap, heading to her bedroom with a storybook. Without warning, “I felt lightheaded. I had no idea what was happening,” said Logue, 41, who works as an environmental planner.

Within minutes, her arm was going numb. She couldn’t form words. She was experiencing classic signs of a stroke.

Fortunately, her husband works from home and the couple had a visiting friend, an ER nurse, in the house. Recognizing the signs of stroke, they called 911 and Logue was whisked about a mile away to Mercy San Juan Medical Center in Carmichael, one of about 100 U.S. comprehensive stroke centers.

In less than an hour, she was undergoing a newer form of mechanical thrombectomy, where a highly flexible thin catheter is threaded into a groin artery and then up into the brain to remove dangerous blood clots. In conjunction with a stent retriever, a tiny mesh tube that grabs a blood clot and suctions it out, the technique is considered a more effective way to quickly treat large blockages.

“These work extremely well. We’re able to navigate directly into the brain and then suction (blood clots) out,” said Dr. George Luh, an interventional neuroradiologist with Dignity Health’s Neurological Institute of Northern California. “It’s a major upgrade in device technology.”

Traditionally, vascular surgeons used ultrasound and lasers or clot-busting drugs to break up blood clots. Stent retrievers, approved by the U.S. Food and Drug Administration in 2012, are a newer innovation, along with new generations of flexible suction catheters. Used at Sutter Health and other local hospitals, they are considered a better way to quickly remove large blood clots.

Removing the pair of blood clots lodged in Logue’s brain took about 15 minutes from start to finish, but Luh said the procedure can run anywhere from minutes to several hours, depending on a blood clot’s location and size.

As part of Logue’s procedure, she underwent brain imaging, using a sophisticated “biplane” camera system that took 3-D images of her brain. On his computer, Luh could view her brain’s blood vessels branching out like graceful tree. In the elegant-looking image, the tiny white nodules that are brain clots are easy to spot.

Designated as a comprehensive stroke center by the American Heart/Stroke Association and the Joint Commission, Mercy is one of only 11 such centers in California and the only one north of the Bay Area. That means it met a number of established criteria, including sophisticated imaging technology, as well as training for coordinated care between emergency medical responders and doctors. Between 2012 and 2015, Mercy’s stroke center participated in two clinical trials using stent retrievers.

Luh, who’s done about 100 mechanical thrombectomies since 2014, said they have been effective in re-opening blood vessels in 90 percent of cases.

Sutter Health also has used stent retrievers in recent years to treat stroke patients. Dr. Lotfi Hacein-Bey, a Sutter interventional neuroradiologist in Sacramento, said stent retrievers “are far superior” as a form of endovascular therapy for some patients with large-artery blood clots who can be treated within six hours of stroke onset.

Time is critical if stroke patients are to avoid permanent brain damage. “Unfortunately, patients often wait to call for help because they expect that symptoms will resolve,” said Mercy’s Luh.

For every 30 minutes of delay in treatment, he said, the odds of a positive outcome drop by 10 percent. “For every minute a large blood vessel is blocked, you lose 1.8 million neurons. That’s significant.”

Nearly five months after her stroke, Logue said the only long-lasting effect from her life-saving vascular procedure is a slight difference in her taste buds. A series of tests and medical evaluations turned up no genetic or physical causes of her blood clots, she said, but doctors believe they likely were a side effect, although considered rare, from oral contraceptives she was taking.

“I feel like I’ve made a remarkable recovery,” she said, standing outside Mercy San Juan’s brain imaging suite where she was a patient in January. “I’m now past the emotional trauma of going through a brain injury ... thinking of all the could-have-beens. I feel incredibly lucky.”

Claudia Buck: 916-321-1968, @Claudia_Buck

Strokes at a Glance

What they are: A blockage in the brain, caused either by a clot obstructing blood flow (an ischemic stroke) or by an aneurysm, where a blood vessel ruptures and blocks blood flow (a hemorrhagic stroke). Less severe is a transient ischemic attack, commonly called a TIA or “mini stroke,” caused by a temporary blood clot that spontaneously dissolves on its own. About 15 percent of all strokes are bleeding strokes, most commonly brain aneurysms; 85 percent are blood clots.

Causes: Blood clots can be caused by irregular heartbeats, plaque buildup in arteries (atherosclerosis) or side effects from certain medications. Risk factors include high blood pressure, family history, age (stroke risk doubles for every decade after age 55), smoking, diabetes, carotid artery disease, atrial fibrillation.

Signs of stroke: Sudden facial drooping, difficulty walking or talking, confusion, numbness on one side, trouble seeing, severe headache.

When to act: To remember signs of a stroke, use the acronym FAST: Face drooping; Arm weakness; Speech difficulties; Time to call 911. Doctors urge prompt action, getting patient to an emergency room quickly to avoid serious brain damage. For more details, go to: strokeassociation.org

What’s a stent retriever: A newer technique to remove large blood clots in the brain, a stent retriever is a tiny mesh tube, typically about 3/4-inch long and 1/6th of an inch in diameter. Used with an extremely flexible, thin suction catheter, it’s snaked from a groin artery up into the brain and threaded past the blood clot. When deployed, the stent retriever springs open and enmeshes itself in the blood clot. As the catheter’s suction begins, the clot is pulled out.

Source: American Heart Association; American Stroke Association

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