The Challenge
Pat Mitchell, a sixty-six-year-old grandfather who operates a wood shop, was enjoying a typical Sunday morning in Latrobe, Pennsylvania: relaxing in front of the TV and drinking coffee. But, as he went to pour a second cup of coffee, he suffered from a stroke.
“And just like someone had flipped a switch, the lights went out,” he describes. “My right side did not function, and I couldn’t speak.”
Pat fell to the floor in his kitchen, where he remained for several hours before his grandchildren and wife discovered him. Because immediate treatment can minimize the long-term effects of a stroke, the delay in discovering him was potentially disastrous.
The Path to UPMC
The paramedics who arrived at the scene were tasked with making the important decision of where to bring Pat for treatment: drive him to a local hospital or airlift him to UPMC Presbyterian, an adult medical-surgical hospital with a Comprehensive Stroke Center. They chose the latter, a decision that Pat is grateful was made on his behalf.
“Thank God that they did,” Pat reflects. “They life flighted me to UPMC, and they operated right away.”
The Solution
Stroke patients are often treated with an intravenous drug called tPA, but the doctors treating Pat were unsure if this alone would be effective in clearing his blood clots due to the delay in getting him to the hospital.
“tPA works well if you can get the drug in early,” explains Dr. Brian Jankowitz, stroke neurosurgeon at UPMC. “It probably works really well in 60 minutes and okay within three hours. The earlier the better.”
Because several hours had passed since he suffered his stroke, Pat’s doctors believed that the best approach to clearing his blood clots was instead a groundbreaking technique called mechanical thrombectomy. In this procedure, which UPMC helped pioneer, a catheter is threaded into an artery at the groin and moved up through the neck until it reaches the blood clot causing the stroke. Using x-ray guided imaging, a stent retriever is inserted into the catheter. The stent reaches past the clot, expands to stretch the walls of the artery so blood can flow, and is pulled backward, removing the clot.
“The new technology that we nowadays have at our disposal allows us to open up these vessels within times that we could only dream about 10 years ago,” says Dr. Tudor Jovin, director of the UPMC Stroke Institute. “And that all translates into more brain saved and better patient outcomes.”
The Results
“When he arrived at our hospital, he was unable to speak at all, and his right side was completely paralyzed,” says Dr. Jovin.
But, within hours of his mechanical thrombectomy procedure, Pat was able to speak and respond to commands. “By day two and three, he was able to move pretty well and walk and made an even better recovery after he was discharged to home.”
Since returning home, the medical team at UPMC has provided comprehensive outpatient care to ensure that Pat continues to improve. This has included physical therapy and speech therapy, as well as the provision of medications that will help prevent another stroke.
“Stroke treatment does not only refer to the in-hospital treatment,” explains Dr. Jovin. “There is a very significant critical component that has to do with rehabilitation that can make a very big difference in terms of outcomes.”
Pat, who was afraid of losing his independence, continues to make forward strides and today, he estimates that he is 95% back to normal. His favorite activities include exercising, completing crossword puzzles, and working in his wood shop.
“I'm extremely lucky to be able to do that,” says Pat. “It means a lot to be able to do it for the craft.” Reflecting on his experience with UPMC, he adds, “The care I received from the EMTs to the surgical team to the nurses to physical therapy has been phenomenal. The surgeons there are top notch in the country.”
