By the time Christine Skolnick reached the Emergency Room on Super Bowl Sunday, a clot had been lodged in her brain for over 8 hours—at least 5 hours past the limit for using clot-busting drugs.
The day had started normally for her. She and her husband Jay had plans for friends to come over and watch the game with them. But then, around 11:00, Christine started to feel nauseous. Her symptoms, which included a mild headache, convinced her that she had a stomach virus. She laid down in her bed to wait it out.
Christine’s husband took over preparations for their small party while coming in to check on her periodically. Around 6:30, though, Jay noticed that Christine’s condition had deteriorated.
“He noticed that the right side of my face was drooping,” Christine recalls. “And I had trouble moving my right arm and leg.”
Jay, a pediatric dentist, recognized these stroke symptoms right away. He called 911, telling them, “I think my wife is having a stroke.”
When the ambulance crew arrived they tried to get Christine out of bed, but her legs wouldn’t support her. Jay had a quick discussion with them. He wanted Christine to be taken to Strong Memorial Hospital, part of the University of Rochester Medical Center. The crew complied. Christine would later learn just how critical that decision was.
At Strong, Christine received both a CT scan and an MRI, with the MRI revealing a clot that lodged in her brain. The doctors determined that the stroke had probably occurred 8-9 hours earlier—when Christine first started feeling sick. The time window for using clot-busting drugs had long since passed. Those medications, administered by I.V., could only be used to break up a clot within 3 hours of the onset of stroke symptoms. Christine’s chances of being rescued by them had passed hours ago.
Fortunately, there was another option. Just a few months earlier, a neuro-endovascular specialist, and his wife, a neuro-endovascular nurse, had arrived at Strong. They brought with them an expertise in a remarkable new procedure that was showing great promise for helping stroke patients.
The neurosurgeon came in to speak to Christine and Jay. He explained that if they did nothing, Christine would not recover the use of her right side. But then he told them about the new minimally invasive procedure, called an endovascular thrombectomy, that might be able to help Christine.
Christine remembers the conversation: “He told me there was a 50% chance of improving, and a 50% chance I wouldn’t. And that included a 10% chance I’d get worse.”
Christine thought about her two teenage boys. She couldn’t bear the idea of leaving them with a disabled mother. For her, the decision was simple.
“I thought, ‘Am I going to do nothing?’” Christine recalls. She and Jay told the doctor they would go ahead with the procedure.
Christine was quickly prepped for surgery then wheeled into Strong’s (endovascular operating room), where the doctor would be assisted by a team that included his wife. “She is really great at keeping everything calm,” says Christine. Christine would be awake throughout the entire procedure.
He then made a tiny incision in Christine’s groin area and then threaded a small catheter into her femoral artery. With the aid of monitors that were tracking the catheter’s location, her neurosurgeon maneuvered the catheter until it reached the carotid artery in Christine’s neck.
Once there, a micro-catheter was inserted that reached right up to the clot in Christine’s brain. A drug called TPA was injected directly into the clot. Christine felt a burning sensation in her neck. There was some hope that this drug would cause the clot to dissolve. In Christine’s case, though, the clot remained lodged firmly in place.
So the doctor went ahead with the next step in the procedure: A tiny wire was threaded through the catheter. The wire extended out from the end of the catheter, reaching just beyond the clot. As he pulled it back, the end of the wire took on a corkscrew shape which grabbed onto to the clot, drawing it back toward the catheter.
As the clot began to move, Christine felt a strong pain and tugging in her head. An instant later, her neuro-endovascular specialist suctioned the clot out, restoring blood flow to the part of her brain that had been blocked. The pain passed and, miraculously, Christine was able to wiggle her fingers and toes again.
“It was amazing,” remarks Christine. “By the time they were finished with the procedure and had that tiny little incision bandaged up, I could move my arm and leg again. I could say, ‘I love you.’”
Christine would spend the next five days in the hospital, and during that time, she improved rapidly.
“By the next morning, I was 60% better,” Christine estimates. “By the time I went home, I was 80%.”
Christine’s progress would continue steadily over the next few months. Three months after her stroke, she described herself as being 99% better. Her only persistent symptom is some hearing loss in her right ear.
Surprisingly, Christine has no family history of stroke, and didn’t have any of the common risk factors. “All of my blood tests were fine,” she says. “My cholesterol is normal, my blood pressure is good.” So the cause of her stroke remained something of a mystery.
Doctors at Strong, though, suggested one possible cause of her stroke: All babies are born with a hole between the two sides of their heart. In most people, this hole gradually closes. But for Christine, it hadn’t. The tiny hole in her heart may have allowed a clot to form and then travel up to the blood vessels in her brain.
Researchers at the University of Rochester Medical Center, led by Dr. Curtis Benesch, are now studying whether closing the hole in the heart can reduce the chance of a second stroke. So four months after her stroke, Christine went back to Strong to have the hole in her heart closed with another minimally invasive surgery.
In the procedure, a tiny incision was once again made in Christine’s thigh. Small catheters were then inserted and threaded up through the arteries leading to her heart. Tiny cameras and surgical instruments were then fed up through the catheters. The cameras would give doctors a three-dimensional view inside Christine’s heart while they precisely manipulated surgical instruments with the aid of a surgery robot.
The primary instrument used in this procedure was a revolutionary device called an Amplatzer Septal Occluder. After it was threaded through a catheter, it emerged and opened like two tiny umbrellas within Christine’s heart. The two umbrellas—which opened up on opposite sides of the hole in her heart—were then squeezed together, closing the hole. The device would stay in Christine’s heart, eventually allowing new heart muscle to grow over it.
Over the course of the next few years, researchers will try to determine if this procedure reduces the chance of stroke victims having another stroke.
Christine has now returned to her normal life, with many of her activities revolving around the two boys who were at the center of her thoughts as she contemplated her revolutionary surgery. She takes an aspirin each day, and a mild medicine for neuropathic pain. She’s exercising more—and enjoying the good things in life.
“It’s really made me appreciate things more,” she says.
Christine says that the speed of her recovery made it hard for her to really appreciate how lucky she truly was.
“Ninety percent of the people who have this kind of stroke die,” she says. “The more I learned about how serious it could have been, the more I appreciated things. I knew it was bad. But because it turned around so quickly for me, it didn’t really sink in.”
For Christine, it seems almost as though her neuro-endovascular specialist and his wife were brought to Strong just for her.
“This is a brand new procedure here,” says Christine. “If this had happened to me 2 months before, I wouldn’t be sitting here. I wouldn’t have recovered.”
“I feel funny calling it a miracle,” she says. “But that’s pretty much what it is.”
Click the links below for related content at URMC.edu:
Strong Memorial Hospital
The Cerebrovascular, Stroke and Endovascular Program