Asheville surgeons use new tool to help stroke victims

Joanne Jurek was sitting at her home computer, puffing on a cigarette and thanking friends for their birthday wishes on Oct. 8 last year when suddenly she felt a strange and scary sensation.

“It was weird,” she says. “I stood up, and everything went numb on my right side. I fell on the bed.”

Jurek heard her partner, Kathleen Krause, say that she was calling an ambulance.

“I tried talking, but it was just a bunch of mumbo-jumbo. It wouldn’t come out in English. I couldn’t walk. I couldn’t talk. I couldn’t do anything.”

Jurek, 53, was suffering a massive stroke. Paramedics rushed the Canton woman to Mission Hospital in Asheville, where she would undergo a procedure that she credits with saving her life.

Doctors used a relatively new device called a stentriever to remove a blood clot that had lodged in her brain. Today Jurek has almost completely recovered and has a new outlook on life.

Stents are mesh, cage-like tubes. Dr. Jonas Goldstein, a neurointerventional surgeon with Asheville Radiology Associates, says that although doctors can place a stent in the brain to open a clogged vessel, the technique has a drawback: Leaving it there could cause more clots, he explains.

So medical professionals got the idea of using a specialized stent that could be retrieved with a wire, “and use it like a snare to pull the blockage out,” Goldstein says.  “That’s why they call them stentrievers, because you are retrieving the stent. These devices, because they work so well and they work so quick, are a huge benefit for patients.”

Stentreivers have been used for years in blood vessels all over the body, he says. The procedure, called a neuro embolectomy, involves feeding a wire and a catheter through a small incision at the top of the leg. The surgical team injects a contrast material into the patient, and uses X-rays to pinpoint the blockage and guide the wire into the head.

“We take the wire and go through the blockage,” Goldstein says. “Once we are through the blockage with the tube, we take the wire out and through the tube we place this stentriever. The stent is all crinkled up very tightly so it can fit through this tiny tub. We snake it all the way up to the tip of the tube, then we unsheathe it, and the stentriever opens up in the clot. We leave it there for about five minutes, then we slowly pull the stentriever back and hopefully pull the clot out with it.”

Goldstein says the procedure must be performed quickly after a stroke occurs, sometimes within three hours or less. As neurosurgeons and health advocates say, “Time is brain.” Surgeons in his practice are on call and must be able to respond to the emergency in 20 minutes so that irreversible brain damage in the patient is avoided or minimized, he says.

“When a part of your brain doesn’t get blood flow, the function goes down,” he says. “You only have a short time [before] it becomes irreversible. Brain tissue is very, very sensitive to not having its energy supply.”

Mission was the second hospital in the state to start using the stentriever in 2011, following approval from the U.S. Food and Drug Administration. Goldstein says there are only about 50 candidates for the procedure among the 700 stroke victims who are brought to the hospital every year. Using it on patients when the blood clot has already caused significant brain loss can actually make the damage worse. Doctors use brain imaging to determine if that’s the case.

“That’s our biggest challenge, to pick which patients we think it’s going to help,” he says. “Strokes are all different flavors.”

Goldstein says only a small percentage of patients achieve a full recovery, but the procedure is a considerable advancement nonetheless.

“We want to try and minimize their stroke,” he says. “We want to give you more chances for better rehab by saving as much brain as possible. What makes this device great is in the past, with the different devices we had, we were able to open up these blockages maybe 40 or 50 percent of the time. With this, it’s up to 80 to 90 percent and it’s much faster. So this is a huge step forward.”

For those who are suffering symptoms of a stroke, getting treatment as quickly as possible is imperative, Goldstein emphasizes. Strokes can cause paralysis and problems with speech and vision.

“I mean anything that you do can be damaged,” he says. “It can make a significant impact on how the rest of your life goes. In some cases if you just left [the patient] alone, that’s the end. Either they’re dead or so disabled they’re in assisted care or can’t take care of themselves. It’s a big burden for families and everything, versus being back and being productive in society and enjoying your life.”

Jurek says she’s extremely grateful to the medical team and emergency responders who quickly got her to the hospital and removed the blood clot from her brain.

“They just wasted no time,” she says. “I thank them every day because if it wasn’t for them I wouldn’t be here.”

Jurek says that after being a heavy smoker for 40 years, the cigarette she was smoking when the stroke hit was her last. She has a new outlook on keeping herself healthy.

“Now I’m trying to eat a lot more vegetables and fruit, and I’m trying to move around and stay active,” she adds. “I’ve probably lost about 50 or 60 pounds. It’s definitely a life-changer. I want to do everything right and I want to be around for a long time.”