New lifesaving options come to Rochester for stroke

May 20 2008

While Superbowl Sunday started out like any other Sunday for Webster resident Christine Skolnick, by kick-off time, things clearly went from bad to worse for the 42-year-old mother of two. An apparent stomach virus and mild headache at midday had, by 6 p.m., become deadly, as Skolnick's face drooped on her right side, and she had difficulty moving her right legs and arms.

A rush to Strong Memorial Hospital confirmed the worse: that Skolnik had suffered a stroke, estimated to have occurred at the onset of her headache - nearly eight hours ago.

With a disease where "time is lost brain," the relatively large time lapse between her initial symptoms and diagnosis severely limited her ability to receive aggressive treatments like clot-busting drugs, which need to be administered within three hours of a stroke.

An MRI scan showed that the source of her stroke was a blood clot in a major artery leading to her brain. At 8 p.m., Skolnick was presented with an option to undergo a procedure which recently became available at the University of Rochester Medical Center (URMC) with the arrival of newly recruited neuro-endovascular expert John Deveikis, M.D., and his wife, Susan F. Deveikis, B.S.N., R.N., the nurse coordinator for URMC's Neuro-endovascular service.

"We told Christine that her opportunity to receive a standard dose of tPA had elapsed nine hours ago, and if we did nothing, she would not regain movement on her right side," Deveikis said. "Or we could try a relatively new procedure that would give her better odds of overcoming her disability from stroke."

Deveikis was referring to a new minimally invasive procedure to remove blood clots in the brain called endovascular thrombectomy. Using a combination of tools, including an important suction device just approved by the Federal Drug Administration in January 2008, physicians can triple the amount of time stroke patients have to receive this treatment that can potentially decrease or even eradicate the debilitating side effects of stroke.

It works by first feeding a balloon catheter from the groin vessels up to the carotid artery. A micro-catheter is guided into the brain until it reaches the clot, and can be used to inject clot-busting drugs directly into the clot. Then, a thin retractable wire is pushed past the blood clot and curls itself into a corkscrew shape. The physician gently retracts the micro-catheter, which in its new corkscrew form can effectively pull the blood clot along until it reaches the carotid artery, where it is suctioned out through the balloon catheter.

Deveikis told Skolnick that if she opted for this minimally invasive procedure, she had a 50 percent chance of improving, or a 50 percent chance of persistent severe stroke symptoms, including a 10 percent chance that her condition would deteriorate.

"It was scary. There wasn't much time to think about it, but I knew I needed to try it. I felt like I didn't have any choice. I needed to get better for me, and for my boys," she said.

Her wish came true - almost instantaneously. Awake and alert during the roughly hour-long procedure, Skolnick recalls feeling a tremendous "tug" in her head, and then, "I was able to talk and move."

For Deveikis, it too was an incredible moment to see that a patient who was almost 10 hours post-stroke have such an immediate and positive recovery.

"Up until recently, we've not had much to offer patients who were not lucky enough to get to a hospital immediately following a stroke," Deveikis said. "With this newer approach, we can expand the window of time to administer clot busting medications, and use minimally invasive techniques to remove the blockage, giving these stroke patients a fighting chance to return to a normal life."

Five days later, Skolnick walked out of the hospital, fully recovered from an ailment that is the leading cause of serious, long-term disability in the U.S., and the third leading cause of death.

The Deveikis' are part of a concerted effort on the part of the neuromedicine physicians at the University of Rochester Medical Center to create a seamless stroke system for Rochester and the surrounding counties, in which patients can access the best treatment for their case, regardless of which emergency department they first arrive at. Currently, URMC stroke specialists oversee care for more than 1,000 stroke patients at Strong Memorial, Highland, and Rochester General hospitals, while URMC neuromedicine neurologists, surgeons and interventionists work on-site at all four of Rochester's hospitals to provide aggressive treatment for stroke when appropriate.

Deveikis has specialized in neuroradiology for the past two decades. He came to the Medical Center from the Medical University of South Carolina, in Charleston, where he was Professor of Radiology and Neurosurgery. Prior to that, he worked for 12 years at the University of Michigan Medical Center in both radiology and neurosurgery. He began his career in the Radiology Department at Georgetown University Hospital in Washington, D.C., where he also served as an Interventional Neuroradiology consultant to the Walter Reed Army Medical Center and the National Naval Medical Center.

He attended the University of Massachusetts Medical School, and completed his residency training at the University of Massachusetts Medical Center, Program in Radiology. He also completed two fellowships in neuroradiology, the first at Georgetown Medical Center, and the other at the University of Western Ontario in Canada

About Stroke

A stroke is an interruption of blood supply to the brain due to a clot or leakage of a blood vessel into the brain. According to the American Stroke Association about 780,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds. Stroke kills nearly 150,000 people a year, making it the third leading cause of death behind diseases of the heart and cancer.

How to Recognize a Stroke (from the Brain Attack Coalition)

• o Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
• o Sudden confusion, trouble speaking or understanding speech
• o Sudden trouble seeing in one or both eyes
• o Sudden trouble walking, dizziness, loss of balance or coordination
• o Sudden severe headache with no known cause

http://www.urmc.rochester.edu