THIS WEEK’S BUSINESS PROFILE: UPHS-Marquette: Transforming stroke treatment with thrombectomy procedures

MARQUETTE — One recent winter morning, Dr. Christopher J. Mehall, a vascular and interventional medicine physician, was reading The Wall Street Journal when he came to a story titled “A Breakthrough Stroke Treatment Can Save Lives — If It’s Available.”

Immediately he sent out an email to his hospital’s public relations department.

“Not sure if you happened to see this from WSJ this morning….. We’ve been offering this 24/7/365 for 6 years,” Mehall wrote in part.

Dr. Mehall’s “we” is UP Health System-Marquette which indeed has offered thrombectomy treatment for years.

It’s a procedure The Wall Street Journal said is “transforming stroke care, pre-empting brain damage in many patients, but the medical establishment is far from making it standard practice.”

UPHS-M indeed can offer a thrombectomy to patients in stroke cases that meet a variety of criteria.

Mehall’s colleague, Dr. Richard Frieden, a brain and spine specialist, said that in a thrombectomy, “the clot removal is done in a very similar way to a cardiac catheter. … A stent line device is used to remove what’s blocking the artery … we pull the blockage out.”

The treatment is not for every stroke patient, however.

“It’s done on a case-by-case basis,” Dr. Frieden said. “There is a lot that goes into it.”

For instance, he said, where the clot is located is an important factor.

“Blood vessels are like a tree trunk going to branches, going to tiny little branches,” he said. “You can’t get the catheter into the tiny branches.”

Using the thrombectomy procedure also is limited by the seriousness of the stroke, as it is an invasive procedure.

“We have to pick our battles,” he said. “Much of this is a question of timing with what we have available. You can’t do (a thrombectomy) after six hours from the onset of stroke symptoms.”

A thrombectomy is a difficult procedure, Dr. Frieden noted.

“It takes a fair degree of specialized training to do the work and a certain volume of demand because if you don’t do the procedure often enough, you don’t stay proficient,” he said.

Dr. Frieden said he imagines most hospitals in large cities do offer thrombectomies and that UPHS-Marquette has two physicians on staff who do the procedure.

“The procedure is not done at Escanaba, Sault Ste. Marie, Houghton or Iron Mountain,” he said. “Those hospitals send their patients here because we’re the only place in the Upper Peninsula that does it.”

The patients they send have to be appropriate candidates for a thrombectomy and one of the two doctors who do the procedure has to be available in the window of time in which the procedure is viable.

“Assuming the patient arrives in time, we have the equipment and the personnel to do (a thrombectomy),” Dr. Frieden said. “We’re a small regional medical center and this is highly specialized medical care.”

Dr. Mehall offered his perspective.

“As Director of Interventional Radiology for over 20 years here at UPHS, I’ve seen the treatment of stroke evolve in many ways,” Dr. Mehall said. “The simple fact is that with stroke, just like with heart attack, time is crucial. Brain tissues dies and function diminishes with every minute that the brain goes without blood flow and the oxygen that it carries.

“About 20 percent of all stroke involve clot that blocks the large blood vessels that feed the brain. It is precisely these blockages that result in the most severe disability, with death rates between 50 and 80 percent and the remaining patients left with severe and crippling disability which will affect them for the rest of their lives,” he said. “Ultimately the only thing that has a chance of preventing or diminishing such disability, to any significant degree, is to restore blood flow to the occluded vascular segment of the brain, either with clot busting drugs like t-PA or with the newer clot removal devices like like the Solitaire device we use here at UPHS.

“We these newer treatment options, it is often possible to restore flow to a significant degree and and potentially prevent untimely death or greatly diminish what would have otherwise been incapacitating disability.”

Dr. Mehall said that everyone should be aware of the signs of a stroke.

“The key to treatment really is the recognition of the problem,” he said. “Some strokes are obvious with loss of consciousness or severe sudden weakness. Some other strokes have a more subtle onset but can quickly devolve and result in the same similar debilitating picture as a rapid onset stroke, again similar to the subtleties seen in some heart attack situations.

“Any person that suddenly develops new weakness in a limb, or rapid onset of confusion or inability to speak or has some obvious facial droop, should be concerned about developing stroke and should be transported to the nearest emergency room immediately,” Dr. Mehall said. “Don’t call your primary care doctor’s office and wait for a call back from the doctor and, particularly, don’t just sit and wait to see if symptoms go away. These symptoms can also be associated with what is called a Transient Ischemic Event (TIA) or ‘mini-stroke’ that may go away in a few hours, but may also be the precursor to a large major stroke that can occurs a few days or even a few hours later.”

Dr. Mehall said UPHS has for years been part of the evolution of stroke treatment.

“We have actually been treating large vessels stroke with catheters for the better part of 25 years, at first with the clot busting drugs, which could be very effective in some cases but were more limited in the time frame that stroke could be treated due to the risk of bleeding associated with oxygen deprived brain tissue,” he said. “The first clot removal devices were brought to market about a dozen years ago and through numerous continuous refinements have become the treatment of choice in large blood vessels occlusions in the brain, allowing for a more extended window for treatment, even now up to 8 or perhaps even 24 hours after the onset of symptoms, and also some further diminution of bleeding risk as compared with older treatment options.

Stroke is a life-threatening condition of which all should be aware, Dr. Mehall said.

“As of 2016, stroke is the fifth leading cause of death in the United States resulting in 140,000 deaths per year in the U.S.,” he said. “But it is also the No. 1 cause of serious long-term disability in the U.S. It is precisely these large vessel blockages in the brain that result in the greatest number of deaths and the most severe disability. It also precisely these cases that we can most impact and potentially, when appropriate, reverse these undesirable outcomes with the new technologies that we have available for these patients.”

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