Vacuum Cleaner for the Brain

Bobbie Laird was suffering a life-threatening stroke triggered by a blood clot in her brain that was nearly half an inch long. But John Whapham, MD, of Loyola University Health System was able to stop the stroke in its tracks by using a cathether device that busted up the clot and suctioned the debris.

Most strokes are caused by blood clots in brain vessels. Brain cells die when deprived of blood and oxygen. But if a patient gets to the hospital in time, fast treatment often can restore blood flow and minimize damage.

When Laird arrived by ambulance at Loyola's emergency room, she was paralyzed on the left side of her body. She was disoriented and losing consciousness. A clot had traveled from her heart and lodged in her right middle cerebral artery, which supplies blood to most of the right side of her brain. As blood backed up behind the clot and congealed, the clot grew to 10 to 12 mm long.

Fortunately, Laird arrived by ambulance within a three-hour time window when treatment is most effective. She was seen by a vascular neurologist and treated with tPA, an intravenous clot-busting drug. There was a slight improvement but it was temporary. So Laird was taken to the catheterization lab to determine if she could potentially benefit from a procedure to extract the blood clot from the clogged vessel.

Whapham inserted a catheter device called Penumbra in an artery in the groin. Whapham guided the device up through the heart and carotid artery into the brain. He deployed a tiny agitator, which broke up the clot, then suctioned the debris through a thin tube. Blood flow was restored to the right side of the brain.

Whapham has done similar procedures on hundreds of stroke patients. He has to work fast, because each passing minute increases the chance of permanent damage. But he also has to be careful not to perforate a vessel in the brain, which could be fatal. "It is a very high stakes procedure," he says.

The FDA has approved the catheter device for clot removal in carefully selected patients. Additional clinical trials are needed to define the role of this and similar devices in the emergency management of patients with acute strokes caused by blood clots,.

— Source: Loyola University Health System