美国国家公共电台 NPR A Lazarus Patient And The Limits Of A Lifesaving Stroke Procedure

 

RACHEL MARTIN, HOST:

About 800,000 people have strokes every year in the U.S. Most are caused when a clot blocks a blood vessel to the brain. We've known about strokes for a long time. But it wasn't until recently that doctors could do anything about them. A clot-busting drug helps some people recover. And now there's another tool doctors can use to treat massive strokes. Irina Zhorov of WHYY's The Pulse has more.

IRINA ZHOROV, BYLINE: On July 17, 2014, Kurt Hinrichs of Gladstone, Mo. went to bed early. He often woke and moved to the couch in the middle of the night. But...

KURT HINRICHS: That particular night, I tried to get out of bed. And I crashed.

ZHOROV: This woke his wife, Alice.

ALICE HINRICHS: At first it was like, what's going on? Are you dreaming? Are you sleepwalking?

K. HINRICHS: And I am thinking that this is a nightmare.

ZHOROV: Alice called 911. When the paramedics arrived, Kurt wasn't speaking, and his entire right side was paralyzed. They recognized that he was having a stroke.

A. HINRICHS: I knew at that point in time, he was not going to come back home through that door. I knew he would be bedridden or in a wheelchair.

ZHOROV: At the hospital, doctors got Kurt on the clot-busting medicine, tPA, but it wasn't working. So they decided to try a new procedure.

K. HINRICHS: They got me on the table, and I was out.

ZHOROV: Doctors inserted a catheter through his groin, wove it up his aorta, the main artery in the body, then into a smaller vessel in the neck and head and finally steered the catheter towards the clot.

BRETT CUCCHIARA: Once it gets into the brain, that's where it becomes a little trickier because the arteries make a lot of sort of sharp turns and curves and do become very small and somewhat delicate.

ZHOROV: That's Brett Cucchiara, a stroke neurologist at the University of Pennsylvania. When the catheter reaches the clot, the doctor pushes out a little wire inside it. On the end of the metal wire is something that looks like a very thin little fishing net.

CUCCHIARA: And it catches the clot in the little mesh. It gets trapped in there.

ZHOROV: Once it's trapped in there, the little net, with clot in tow, is pulled out of the body.

CUCCHIARA: Somewhat analogous to, like, a plumber who comes and uses the plumbing snake to pull a clog out of your drain.

ZHOROV: Blood flow immediately returns to the brain.

CUCCHIARA: Many times, within 10 or 15 minutes of that happening, the paralysis will melt away. Their ability to speak will completely return. So it can be quite a remarkable, almost miraculous recovery that you can see right in front of you.

ZHOROV: Alice Hinrichs had left the hospital while Kurt was recovering from the procedure. When she returned just hours later, she found Kurt moving his right arm and leg. And he was speaking.

K. HINRICHS: She walked into my room. And about this clearly, I asked her, how is your morning?

A. HINRICHS: (Laughter) What, my morning? What about your morning? And I just kind of stopped. And I looked behind me, and I looked at him. And I'm like, my gosh, what happened while I was gone?

ZHOROV: Kurt is what doctors sometimes call a Lazarus patient. His massive stroke could have killed him or left him handicapped. But he walked out of the hospital without any serious lasting effects. Not all patients have such remarkable recoveries, but 2015 guidelines made the procedure standard care. The problem is not all qualifying patients are getting it yet. Guillermo Linares, director of neuro-interventional services at Temple University Hospital, says people have to call 911 as soon as they start to see symptoms.

GUILLERMO LINARES: And the ambulance has to arrive quickly. The stroke has to be identified. The patient has to be brought to a stroke center.

ZHOROV: Everything has to happen quickly, but not all places have comprehensive stroke centers. In rural areas especially, medical teams have to figure out what to do with stroke patients.

LINARES: Should they drive you to the closest possible hospital? Or should they drive past a smaller hospital in order to get you to a larger, comprehensive stroke center where more options may be available? Well, there's risks and benefits to either path.

ZHOROV: Figuring out an efficient way to get patients help quickly will be one of the next big advances in stroke care. For NPR News, I'm Irina Zhorov.