Stroke Patient Survives From Timing, A New Device & A New Doctor

(August 31, 2012) - You’ve heard the phrase, “timing is everything.” You’ll get no argument about that from 55-year old Arvest Bank loan processor George Berger of Springdale.

Two weeks ago, George felt a pop in his neck, and he collapsed from what he would soon learn was a massive ischemic stroke. Fortunately, his partner of 12 years, 40-year old John Jones, discovered George only moments later, becoming paralyzed on his right side and unable to speak. Neither man knew it then, but from that moment, George had about a four-hour window during which it would be safe for him to receive a drug called tissue plasminogen activator (tPA), commonly referred to as the “clot buster” drug. It’s the most effective first line of treatment for his particular type of stroke.

Timing played in George’s favor when the ambulance driver rushed him to Northwest Medical Center, which provides acute stroke care through a telemedicine partnership with Sparks Regional Medical Center, more than an hour’s drive south in Fort Smith. Sparks is highly acclaimed for its excellence in stroke treatment.

George had never heard of telemedicine, but he does remember seeing Neurologist Margaret Tremwel, MD, on camera and “hearing her talk with the staff and John” as she evaluated his condition from her laptop, which she carries with her everywhere.

“The videoconferencing was great, because I felt informed,” John said. “Dr. Tremwel explained everything that was happening to George.”

John didn’t know it, but at the time of George’s Code Stroke call, Dr. Tremwel happened to be at Sunday worship service. She was talking to him from a quiet room at church – a fact believers will note as perhaps another “stroke” of good timing.

After getting John’s consent, Dr. Tremwel ordered the staff in Springdale to administer the clot-busting tPA injection, but “some patients have very large clots in major arteries and the clot buster can’t remove it,” said Tremwel, who added, “Mr. Berger’s stroke was huge. He was not responding well.”

Knowing that “time saved is brain saved,” she wasted none, ordering George to be transported to Fort Smith via helicopter and calling in Sparks’ second line of stroke defense, her new colleague, Clint Wood, MD, a fellowship trained Interventional Neuro-Radiologist who specializes in the non-invasive removal of blood clots from the brain. He had been practicing at Sparks for about three weeks.

Dr. Wood arrived at the hospital just in time to meet the helicopter, and George was rushed in for a brain scan.

“When we saw Mr. Berger’s new images, it was clear, he never would have made it to Little Rock,” said Dr. Tremwel. “That’s where he would have been sent before we had Dr. Wood here.”

By this time, George’s blocked vessel was supplying just a trickle of precious blood to sustain a full half of his brain. The tPA had kept him alive “just long enough for the helicopter ride,” said Tremwel.

His vessel was completely re-clotting. Time kept ticking..

The New Device

Dr. Wood says the type of stroke George suffered was “practically a death sentence” before physicians like him began inserting tiny clot retrieval devices up through the groin and threading them into the arteries of stroke patients’ brains.

As fate would have it, the device he wanted for this particular case, the “Solitaire,” had been approved by the FDA just months before. Unlike the standard, corkscrew-type clot remover device, the Solitaire has a self-expanding, stent-like design, and once it’s inserted into a blocked artery, it compresses and traps the clot before removing it. Studies had shown the Solitaire could dramatically outperform its predecessor in opening blocked vessels without causing bleeding in or around the brain.

Dr. Wood used the new technology to successfully break up and remove George’s clot, restoring blood flow within 20 minutes.

George says he remembers Dr. Wood asking him “if I knew where I was” before they took him out of the procedure room. He does not remember the team’s gasp of elation when George actually spoke the words, “Fort Smith.”

Sparks’ Chief Nursing Executive, Cindy Slaydon, later said Dr. Tremwel was “in the clouds,” adding, “She thought the patient had no chance.”

You can probably guess the end of this story. George is now home and expected to make a full recovery with no lasting damage. None.

He may still not truly grasp his victory against the odds.

“Dr. Wood and Dr. Tremwel seem to know what they’re doing,” George said, several days after his procedure. “I want to tell them how happy I am they made the effort to help me survive.”

Comprehensive Stroke Team

“This absolutely was a team effort,” said Dr. Tremwel. “Everyone, from the ambulance to Northwest Medical to the entire team at Sparks did their job perfectly in this case.”

Unfortunately, it doesn’t work out that way for most stroke victims. In truth, from prevention to diagnosis to treatment, strokes are too often a litany of missed opportunities in our country. George is one of an estimated 790,000 Americans who will have a stroke this year, but one of the very few who end up at a hospital with the medication, equipment and expertise to accurately diagnose and treat it.

Rarer still is the stroke patient who has quick enough access to the complete array of neurovascular services that Sparks now provides. In addition to a team of neurologists like Dr. Tremwel and the interventional stroke and aneurysm treatments provided by Dr. Wood, Sparks employs neurosurgeon Shawn Moore, MD, who performs open brain surgery when necessary. That triumvirate allows for the treatment of any stroke of any severity, including dangerous erupted brain aneurysms, an obvious benefit not just for nearby Fort Smith patients, but for patients throughout the Northwest Arkansas/Northeast Oklahoma region via telemedicine technology.

Sparks currently provides the telemedicine service to Sequoyah Memorial Hospital (Sallisaw), Haskell County Hospital (Stigler), Eastern Oklahoma Medical Center (Poteau) and Choctaw Nation Hospital (Talihina) in northeast Oklahoma, and to Northwest Medical Center (Springdale), Northwest Medical Center (Bentonville) Washington Regional Hospital (Fayetteville), Johnson County Medical Center (Clarksville), Mena Regional Hospital (Mena), Booneville Community Hospital (Booneville) and St. Mary’s Hospital (Russellville) in northwest Arkansas.

“Our goal remains what it’s been for the past ten years,” said Dr. Tremwel, whose passion for her life’s work is obvious. “We will reduce the death rate and incidence of stroke and other vascular episodes in our region.”

It worked beautifully for George Berger. Thank goodness the same may now be true for any stroke patient in the region who follows.