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fessler resizeA new generation of devices coming to Michigan hospitals could significantly improve care for patients who have some of the most devastating types of strokes. The Solitaire flow-restoration device, which gained federal approval last month, is used in the brains of stroke patients much like an artery-opening angioplasty procedure for heart blockages.

Robert Lee Burns, 73, of Clay Township credits it with saving his life.

"I thought it was over," said Burns. "Maybe there wasn't enough room upstairs for me yet."

A retiree who has worked on oil rigs and automotive assembly lines, Burns was one of the first five Michiganders to undergo the procedure. His surgery was Monday at St. John Hospital and Medical Center in Detroit.St. John is the first hospital in southeast Michigan to use the device. The Detroit Medical Center and Henry Ford Health System, both based in Detroit; the Oakwood Healthcare System in Dearborn and Beaumont Hospitals, Royal Oak, are among those planning to add the technology soon.

"This is a very promising new technology," said Dr. Sandra Narayanan, a DMC interventional neurologist. "I think it's going to be a game changer."

Doctors hope the new device proves to be more effective and easier to use than the first generation of products, which worked in a similar way, but weren't as good at removing clots. Studies of the new device in Europe and Canada show that it significantly improved stroke outcomes.

"We hope to replicate some of the results," said Dr. Andrew Xavier, director of interventional neurology at Oakwood.

Just a little more than a decade ago, doctors had few options for patients with the most devastating strokes that cause blockages in the brain. The addition of a drug called a tissue plasminogen activator (tPA) helped many people, but doctors say that as much as 40% to 50% of the time, the clot is too big to dissolve with the drug, which ideally is given within the first hour of stroke symptoms and no more than 4 1/2 hours later. Earlier devices also were technically demanding to use and proved a challenge for all but doctors in high-volume practices who performed the techniques often, said Dr. Richard Fessler, chief of surgery for the St. John Providence Health System.

The Solitaire device, made by Covidien of Dublin, Ireland, is minimally invasive. Doctors thread a thin tube through an artery -- typically in the top of the leg -- up to the brain. Then they advance within that tube another instrument with a miniature, Slinky-like stent to the blockage. The stent expands and helps doctors remove the clot more easily. To be sure the blockage is entirely removed, doctors take pictures of the arteries. 

Burns, known to many in the Algonac area as Scrapper Bob because he salvages yards for scrap, was returning home in his truck Monday afternoon when he felt his right hand and leg go numb. He had not felt well that day, he recalled. "I thought, 'My God, I'm having a stroke,' " Burns said. He pulled over to get his phone out of his right pocket, but he was too weak to retrieve it. A man who saw him outside his home responded to his call for help.

A computer tomography (CT) scan at St. John River District Hospital in East China Township found that he had a blockage that was so big it was unlikely it would be helped by tPA, Fessler said. An ambulance brought Burns to River District's bigger sister hospital, St. John in Detroit.

Burns already is taking steps, has slight numbness but no major paralysis or other stroke complications and most likely will be able to go home soon. He should be able to get back to his life with a few weeks of physical therapy, Fessler said. "He's doing beautifully."

 

-An article in the Detroit Free Press on April 1, 2012
By: Patricia Anstett
Detroit Free Press Medical Writer

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