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A new approach to extracting blood clots holds life-saving promise
Physicians at Rhode Island Hospital’s Comprehensive Stroke Center are pushing the limits on treating what would typically be deadly or debilitating clots, and 74-year-old Rosetta McCall is among the fortunate patients who’ve benefitted.
McCall woke up with symptoms of stroke, including a nondescript “strange feeling,” inability to properly use her right hand for tasks like taking her morning shower and impaired speech. She spent that morning by herself, going about her usual routine, even driving herself to an appointment near her Riverside home.
Rosetta used to work for Brown University’s medical school, acting out medical symptoms for students to diagnose. Suddenly, one of those scripts was playing out in reality. “I looked in the mirror and I thought I saw a little bit of droop, and I remember saying, ‘Am I having a stroke?’ But I don’t know if I was saying it out loud.”
Rosetta’s husband, Daniel, called her that day and after speaking with her knew something was wrong. He came home immediately and found her sleeping on the couch. When she woke and seemed not to recognize her husband of 54 years, he called an ambulance.
Rosetta was transported to The Miriam Hospital, where she was evaluated and diagnosed by the stroke team as having a large vessel occlusion, a particularly deadly or permanently debilitating type of stroke in which blood to a large area of the brain is blocked. The Comprehensive Stroke Center was immediately put on notice, and she was transferred to Rhode Island Hospital, where she had the good fortune to be in the hands of Mahesh Jayaraman, MD, and Ryan McTaggart, MD.
Rosetta had suffered from her symptoms for upwards of eight hours now. Normally, so-called clot-busting medicines and stent retrieval clot extraction procedures are thought to benefit patients only in the first four to six hours from the onset of stroke symptoms. Dr. Jayaraman and Dr. McTaggart are challenging that notion through the use of advanced MRI to determine the extent of damage caused by the blockage. Rosetta’s MRI showed that much of the affected area was not yet permanently damaged, so a small catheter was threaded through an artery from her groin up to her brain; the removal of the clot instantly restored her blood flow.
“We call this a home-run save,” said Dr. Jayaraman. “This is an example of someone who would have been debilitated, unable to communicate, unable to move the right side of her body, and instead, less than three months after her stroke, is completely back to normal. In fact, she went home two days after her stroke.”
The clot extraction procedure itself is a recent practice in stroke treatment, only performed regularly in the last several years and even then primarily in Comprehensive Stroke Centers like Rhode Island Hospital. Expanding this treatment outside the traditional window of time from the onset of symptoms could prove revolutionary, and Rhode Island Hospital is one of just a few sites in the country participating in a trial to measure effectiveness of cases like Rosetta’s. Dr. Jayaraman and Dr. McTaggart are seeing great results so far.
Meanwhile, Rosetta is eagerly anticipating her return to a favorite pastime of hers and her husband’s. “My fall league starts in a couple of weeks. I am ready to go back to bowling,” she said, as she flashed an enormous smile.