Stroke victims get new chance. Device goes into the brain and removes clot

Stroke victims get new chance:
Device goes into the brain and removes clot
Sunday, May 07, 2006
Star-Ledger Staff
Traci Miller had just gotten up to put her 3-year-old daughter, Alexis, back to bed. While she was up, she decided to take a shower.

She never made it.

Without warning, the 35-year-old Hackettstown mother of two was felled by a stroke.

When her husband, Michael, heard her fall, he ran into the bath room and found her leaning against the tub. She was crying and moaning, but could not respond. She also could not move the entire right side of her body. Michael Miller called 911.

He would later learn blood flow to his wife's brain was being blocked by a clot.

That was just a month ago, on April 8. Now Traci Miller is back home and expected to recover fully, after doctors at Overlook Hospital in Summit used a new device to remove the clot.

Overlook, part of the Atlantic Health System, is the only New Jersey hospital using the Merci Retrieval System, which resembles a small corkscrew. Using catheters and guided by X-ray, doctors thread it through the arteries, starting at the groin, snaking it up to the brain.

The clot is then captured by the wire corkscrew and pulled into a large catheter before being sucked out of the body.

Miller was transferred to Overlook on the day of her stroke.

One of the advantages of the Merci System, developed by Concentric Medical of Mountain View, Calif., and approved by the Food and Drug Administration in 2004, is that it can be used in patients eight hours or more after a stroke.

"We have had patients who would have been dead wake up on the table and instantaneously re gain consciousness," Gary Curtis, Concentric's president and CEO said, noting about 3,000 patients have been treated worldwide. The success in restoring blood flow is about 70 percent, he said.

Medication typically given intravenously to dissolve clots, called TPA (tissue plasminogen activa tor), must be used within three hours of the onset of stroke symptoms to be optimally effective.

Miller's doctors decided to use both TPA -- which was not enough to dissolve her large clot-- and the Merci procedure. Doctors injected the TPA directly into her brain, another aggressive treatment some are now using to treat stroke, al though it is not FDA approved.

"They told me this treatment was her best hope, so I signed the papers," Michael Miller said.

He knew there were risks.

Bleeding is a complication of TPA and the corkscrew procedure, and in dealing with such delicate blood vessels in the brain there is always a chance of perforating an artery.

Doctors using the clot removal device must undergo special training, said Pierre Gobin, the New York Presbyterian Hospital doctor who invented it.

"It is technically challenging to do this procedure," he said, noting the corkscrew is smaller than a penny.

Ron Benitez, the attending interventional neurosurgeon at Overlook who removed Miller's clot, said the risk was worth it, given the fact she could have died or been severely and permanently disabled.

"She had a complete blockage of the main artery on the left side of her brain," he explained.

The procedure took about two hours.

Later that Saturday night, Traci Miller could whisper the words "I love you," and also started to move her right leg.

Two days later, she was out of bed, getting around with the help of a walker and holding a conversation. At week's end she was transferred from Overlook to the Rehabilitation Institute at Morristown.

"She was getting better day by day," her husband said. "They told me she was a miracle."

Traci Miller's only known risk factor for stroke was that she was taking birth control pills. While she was hospitalized, however, doctors discovered a hole in her heart that had not closed as it should have during fetal development. Doctors at Overlook plan to repair it in a later procedure.

"Normally, if you have a clot that might develop in the legs or the pelvis, it might get filtered out by the lungs," Benitez explained. "In these patients, that blood clot is able to go through this hole and ends up in the brain, causing a stroke."

Miller was left with some blur ring in her left eye. She still has dif ficulty with word retrieval at times and is working on higher-level cog nitive skills with a speech therapist at Hackettstown, where she is now getting outpatient therapy.

She also receives occupational therapy, primarily directed toward strengthening her right side. Miller, who had worked full time as a fi nance manager at a pharmaceuti cal company before the stroke, also injured her right shoulder.

"She's an exception and has higher level functioning than what we usually see after a stroke. She's doing great," said Christine Bove Ferreira, her speech therapist.

As for Miller, she is just happy to be home with her two girls, Alexis and 1-year-old Rylee.

"She got so much function back so quickly. ... At her age, I expect her to have a complete recovery or come very close," Benitez said.

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