Written by SMH Senior Communications Editor Kim Savage
Kati Council was jump-starting her day with an early morning CrossFit class when an intense dizziness enveloped her and she suddenly sank to the floor.
SMH Neurologist Juliette Coleman, exercising beside Kati that morning, immediately recognized the signs of a severe stroke. In the minutes it took paramedics to arrive, Kati was unable to walk or talk and completely paralyzed on her right side.
The physician knew Kati would need more than the standard clot-busting drugs available in most emergency rooms. She urged rescue workers to bypass closer hospitals and take Kati directly to Sarasota Memorial Hospital’s Comprehensive Stroke Center.
Kati’s best chance for recovery was an advanced endovascular procedure called a thrombectomy — a relatively new therapy gaining favor for its ability to prevent brain damage in stroke patients.
Coleman knew what many do not: SMH is the only hospital between Tampa/St. Pete and Fort Myers that can perform the thrombectomy — and it’s one of the safest places to have a stroke.
Time Is Brain
Strokes often come without warning, affecting someone in the U.S. every 40 seconds. It is the leading cause of disability in our nation and the fourth leading cause of death.
Nearly 90 percent of strokes are ischemic, caused by blockages disrupting blood flow to the brain. The sooner the clot can be cleared, the greater the chance of a good outcome — nearly 2 million brain cells die every minute that blood flow is blocked.
In Sarasota County, paramedics use a stroke scale to determine the severity of a stroke in the field, and in worst cases, they transport patients directly to SMH by ground or by air.
Most ERs are equipped to administer the standard clot-dispersing drug tPA, which can dissolve a clot if given within three to four hours of onset. But for Kati — and up to 25 percent of all ischemic stroke victims with larger clots blocking major arteries to the brain (called large vessel occlusions) — tPA might not be as effective; a combination of tPA and thrombectomy often is needed.
“With those kinds of strokes, you have to open the artery, and you have to do it fast,” said stroke neurologist Mauricio Concha, MD, medical director of Sarasota Memorial’s Comprehensive Stroke Center. “Without advanced intervention, people often die or are left with severe, permanent disabilities.”
Cutting-edge Clot Removal
Kati’s clot completely blocked flow through her basilar artery – the kind of clot that kills 80 percent or more patients.
Kati said she remembers the ambulance doors swinging open and being surrounded by a sea of scrubs: SMH’s 24/7 rapid response stroke team met her at the door. Within 20 minutes, the stroke team completed the array of tests needed to begin safely administering intravenous tPA and transfer her to the thrombectomy suite.
There, neuro-interventional radiologist Daniel Case, MD, used sophisticated neuroimaging studies with CT scans to identify the parts of the brain damaged by the stroke and the areas salvageable through thrombectomy.
With real-time imaging guidance, Case threaded a tiny catheter from her groin to the blockage in her brain and deployed an endovascular device called a “stent retriever” to physically remove the clot, immediately restoring blood flow to her brain.
In less than three hours, Kati was resting comfortably in a hospital room, wiggling both toes and speaking reassuringly to her husband and three children. She went home a few days later without any deficits.
“I know most people die from the kind of stroke I had,” Kati said, recalling her health scare in February 2017. “My youngest daughter was 7 at the time, and that really hit home, because I was 7 when my father passed away. I know that loss ... Thanks to the SMH team, my children didn’t have to experience that.”
Delays in Care
Others are not so lucky.
Three years after six landmark clinical studies proved the benefits of thrombectomy, many stroke patients still are not getting it. Instead, they linger in hospitals that lack the specialists to perform the procedure, spending hours undergoing tests and scans. If they are lucky enough to receive tPA, more hours pass as doctors wait to see whether the drug will work.
“The latest studies show there’s a 1-in-2 chance of them getting better with a thrombectomy, even 24 hours after their initial symptoms,” Case said. “But we are still the only hospital [in the area] doing it. Others either don’t know or don’t accept the importance of these studies.”
It leaves SMH stroke specialists with an ethical question: How hard do you fight to ensure local stroke patients receive the higher level of care?
SMH’s stroke team is reaching out to physicians and other hospitals to encourage more timely transfers, sharing the studies and thrombectomy treatment recommendations from the American Heart Association/Stroke Association.
“When you see these patients wake up after an intervention, like I do, it changes your world,” Case said. “Other hospitals need to step up and bring in the specialists who can provide advanced treatments, or step back and let EMS bring those patients directly to us.”
The best way to protect yourself from stroke is to reduce your risk factors, recognize the signs and know what to do in the event of a stroke.
Click here to read
our “Stroke Prevention, Symptoms and Recovery” blog, or click here to watch
a recorded, “Ask An SMH Expert” livestream Q&A on stroke and stroke prevention.
Kim Savage is Sarasota Memorial's public information officer and senior communications editor, overseeing media relations and external communications for the health system since 1999.