July 29, 2015, ST. LOUIS - A winter storm in February brought heavy snowfall, forcing Bob Ohlendorf to get out his four-wheeler and start clearing his property. While plowing the snow, however, Bob suffered a stroke and subsequently crashed into the garage door. Around that same time, his son, Mike, called his cell phone and noticed Bob's slurred speech. That's when Mike knew something was wrong.
With Bob's wife, Barb, at work in St. Louis, Mike asked his wife, Amanda, who also happens to be an ICU nurse, to walk next door to check on Bob. When Amanda arrived, she saw that Bob was completely paralyzed on his left side. She wasted no time and called 911.
Upon hearing Bob's symptoms, the paramedics knew they were dealing with a stroke patient. That's when they made the decision to take him to SSM Health Saint Louis University Hospital. The paramedics were familiar with the MidAmerica Stroke Network and knew Bob may benefit from seeing one of the stroke specialists on staff at the hospital.
"Since they were taking him to SLU Hospital, I knew Bob's condition was serious," recalled Barb. "I quickly left work in South County and headed to the hospital. I figured I would be waiting for them to arrive, but they actually beat me there."
The stroke team, led by Randall Edgell, MD, a SLUCare interventional neurologist at SLU Hospital, was waiting for Bob. They administered tPA upon his arrival; however, it didn't seem to be working. His left side was still completely paralyzed.
"Bob was experiencing a life-threatening right middle cerebral artery stroke caused by a blood clot lodged in the artery. Without restoring blood flow, we knew he would certainly be disabled the rest of his life if he survived," said Dr. Edgell. "Bob's blood clot was quite large, and the tPA wasn't dissolving it. So we recommended a thrombectomy procedure that uses a retrievable stent to remove the clot. We knew it was our best chance to reverse the effects of the stroke."
When it comes to stroke, time lost is brain lost…approximately two million brains cells per minute.
"As soon as blood flow is halted by a clot, the brain tissue that is supplied by that blood starts to melt away," said Dr. Edgell. "For every minute that blood flow is cut off, nearly two million brain cells will die. There is no other organ in the body that's as sensitive to lack of blood flow."
Historically, the treatment for acute ischemic stroke (AIS) has been the drug, tissue plasminogen activator (tPA), which can dissolve clots. However, this isn't always effective when treating larger clots. In some cases, another treatment is needed to help remove these clots.
According to a major landmark study and supporting studies recently published in major medical publications such as the New England Journal of Medicine, an interventional stroke procedure – stent thrombectomy using a retrievable stent – demonstrated a significant clinical benefit when added to pharmaceutical treatment (such as tPA) for AIS patients compared to using pharmaceutical treatment alone.
"This is a transformative moment in how we treat stroke," said Dr. Edgell. "Using a wire mesh cylinder that allows us to access the brain arteries and the blood clot, we can retrieve the entire clot along with any surrounding fragments, restoring blood flow to brain much more quickly."
The retrievable stent has been used at SLU Hospital for several years. This latest clinical research just confirms what neurospecialists like Dr. Edgell have known all along: the retrievable stent is a game-changer that's impacting outcomes.
Dr. Edgell reassured Barb that the results of this retrievable stent procedure had been very positive for numerous other stroke patients. She didn't hesitate and consented to the procedure in a last measure to save Bob's life. Less than four-and-a-half hours after the stroke, Bob was undergoing surgery to remove the clot. Dr. Edgell and his team were able to open the artery 70 minutes later.
Thankfully, it was the right decision. Bob awoke from surgery in the ICU to find that his paralysis and slurred speech were completely reversed. He was back to fully functioning as soon as the clot was removed. An occupational therapist and physical therapist verified the results. Bob was discharged home two days later.
"I was stunned to see him recover so quickly and completely. It was almost like it never happened," said Barb.
Bob took some time off work to recover from his stroke. However, he returned to driving trucks full-time and continues to do so more than a year after his event. Fortunately, other than some fatigue, Bob hasn't experienced any residual effects from the stroke.
"I'm really lucky that things turned out the way that they did," said Bob. "Without the retrievable stent procedure, things could've gone very differently."
Bob's stroke was caused by atrial fibrillation (AFib), a condition that had gone undiagnosed until after his stroke. He also has a family history of high blood pressure. Both of these conditions put Bob at a greater risk for stroke. He is currently taking Coumadin and a few other drugs to help manage his condition, and hopefully prevent another stroke.
For more about the new option in treating stroke, visit our MidAmerica Stroke Network site.
