New stroke treatments work miracles

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Alyssa Cwanger, Post-Gazette
Mary Russman hugs her sons Zachary, 9, left, and Luke, 5, in their home. She and her husband, Mike, also have a daughter, Rachel, 11 months . Friends were visiting her in September when she suddenly couldn?t speak. She was taken to Mercy Hospital, where doctors removed the clot that caused her stroke, and she quickly recovered. Mrs. Russman remains grateful that she was not alone and that others quickly helped her get expert care.
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In their own words

The survivor: Mary Russman describes the day she suffered a stroke and the medical treatment that allowed her to walk out of a hospital with no visible ill effects just days later:

"You have to come quickly," my neighbor said. "My friend has had a stroke."

Overnight she went from feeling trapped in her body to being able to ask to go home.

Her recovery was rapid and complete.

Faith and a TV show helped her decide to under the MERCI procedure.

She never thought she could have a stroke. Thankfully it happened under optimal conditions.

Fortunately her neighbor recognized she was having a stroke.

Her next goal is to walk in a marathon this summer.

The physician: In a telephone interview, Dr. John Baker discusses the medical technology that provided such a favorable outcome for Mrs. Russman:

Seeing Mrs. Russman hold her baby less than 24 hours after having a stroke was "an amazing sight."

The treatment for Mrs. Russman included the drug tPa, followed by a surgical procedure to remove blockage in a major artery in her brain.

Mrs. Russman's miraculous recovery was in part due to her age, good health and her body's ability to use alternate pathways for blood in the brain.

How the MERCI device works.

How Mrs. Russman's blood clot traveled to the brain.

The specialized treatment Mrs. Russman received is available at just a few hospitals.

Comprehensive stroke center guidelines are still being developed.

Efficient two tier treatment is in the best interest of the patient.

A neighbor and her children were visiting one afternoon last September when Mary Russman suddenly "felt very strange." Her right side went numb, her right arm seemed impossibly heavy and she could not speak.

As her neighbor suspected, Mrs. Russman, of North Huntingdon, had suffered a stroke. A blood clot had blocked an artery feeding areas of her brain that control speech, language comprehension and right-side movement. If the blockage stayed in place, those brain areas would likely die, making her impairments permanent.

But a paramedic, Bart Brier of North Huntingdon Rescue 8, remembered reading about new stroke treatments at Mercy Hospital. The rescue team took her there, where doctors initially were unable to clear the blockage using the clot-busting drug tPA. But then they tried a corkscrew-shaped device called the MERCI retriever to remove the clot.

After Mrs. Russman, then 38, awoke later that night and her ventilator was removed, she fluffed her hair with her right hand and announced, "I want to go home."

It was another case of a tragedy largely averted thanks to a growing number of stroke therapies, many as-yet unapproved by the Food and Drug Administration, that have been developed since intravenous administration of tissue plasminogen activator, or tPA, was approved for halting strokes a decade ago.

The treatments benefit many patients who arrive too late for intravenous tPA, which must be administered within three hours of the start of stroke symptoms. Many of the newer therapies can be used six hours or more after symptoms appear.

But relatively few hospitals offer them, in part because they require special expertise to administer. In Western Pennsylvania, they are available at the major Pittsburgh hospitals and some other centers.

In general, the newer therapies open arteries better than intravenous tPA, said Dr. Lawrence Wechsler, director of the University of Pittsburgh Medical Center's Stroke Institute.

They also appear to improve patient outcomes, though the large studies necessary to prove that haven't been done yet, he said. Of the alternatives to tPA, only the MERCI retriever, which is threaded through the groin and into blocked arteries, is FDA-approved.

The newer treatments significantly expand the pool of stroke patients who can receive acute treatment. At UPMC Presbyterian, they help about 10 percent of acute stroke patients in addition to the 10 percent who receive intravenous tPA, Dr. Wechsler said.

Some patients who are helped can't qualify for tPA because they have had recent bleeding or other conditions. For others, including Mrs. Russman, tPA fails to clear the blockage, particularly in larger blood vessels.

Sometimes, a combination of therapies can be helpful, said Dr. Ashis Tayal, medical director of Allegheny General Hospital's comprehensive stroke program.

The effectiveness of acute stroke treatment depends in part on how quickly the stroke progresses.

Typically, stroke causes an area of permanent damage in the brain, with a surrounding area that has impaired circulation. If doctors can intervene and improve blood flow before the threatened tissue also dies, patients may be spared debilitating injury or death.

For Ray Pokorny, timely intervention likely saved his life.

On Aug. 11, he had headaches and blurred vision and thought he had sinus problems. Later that day, co-workers at the Allegheny County Airport Authority found him slumped over his desk.

He was taken to Allegheny General, where doctors found that an artery supplying blood to the back of his brain was severely blocked with plaque and a blood clot.

Dr. Andrew Ku, an interventional neuroradiologist, used a catheter inserted through the groin and threaded into an artery so he could administer tPA directly to the clot. He also used a tiny balloon to widen the narrowed vessel.

Mr. Pokorny has not returned to work and is unable to play jazz piano as he once did. But he is taking piano lessons and doing chores at his Jefferson Hills home.

"It's good to be around," said Mr. Pokorny, 52.

Doctors also are treating acute stroke patients with stents, the mesh metal devices often used to prop open arteries damaged by coronary artery disease.

A recent study led by Dr. Tudor Jovin, co-director of UPMC's Center for Endovascular Therapy, found that stenting procedures successfully opened internal carotid arteries deep within the neck in 23 of 25 patients.

Doctors have used stents for years to clear plaque from the common carotid arteries on each side of the neck, blockages that can be a risk factor for stroke. While the plaque can be removed surgically, stenting is considered a better option in high-risk patients.

Drugs and the lowering of body temperature also are being studied to determine if they can protect the brain from the damaging effects of stroke.

Doctors noted that in some cases, the newer treatments for stroke can be effective in patients even after many hours have passed. But in general, the sooner blocked arteries are opened, the better.

Failing to clear Mrs. Russman's blockage could have resulted in devastating injury or death, said Dr. John Baker, director of the neurovascular center at Mercy Hospital.

Mrs. Russman remains grateful that she was not alone when she had a stroke and that others quickly helped her get expert care.

God orchestrated the day's events, she said, for her to be "in the most optimal circumstances for such a horrific thing to happen."

Joe Fahy can be reached at 412-263-1722 or . Audio produced by Curt Chandler, who can be contacted at .


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