Advances in Stroke Care

A patient is undergoing an MRI scan to look for signs of a stroke. Credit - NIH Image Bank.
A patient is undergoing an MRI scan to look for signs of a stroke. Credit - NIH Image Bank.

FERGUSON: Ah, beautiful. Okay.

FERGUSON: (sounds of scrolling…) So the eyeballs, the nose, the mouth, the jawbone, the neck, the sternum, collarbones here, muscles of the neck, and then we get into the blood vessels.

Dr. Robert Ferguson, an interventional neuroradiologist at MetroHealth, looks at black and white images like this one, taken from a CAT scanner, day in and day out. They let him peek inside the body without having to wield a knife or thread a tube.

FERGUSON: So blood vessels in the brain are sort of like meandering rivers. They curve right to left and zigzag back and forth.

FERGUSON: So here are the carotid arteries going up into the neck. And then we can actually see the blood vessels inside the head very nicely.

Ferguson takes a closer look.

FERGUSON: We see a nice squiggly line on one side that represents a normal filling blood vessel and on the other side, we see that the line abruptly ends, it doesn't continue

This--this is the problem--a big problem. A 74 billion dollar a year, life and death and permanent disability kind of problem. Stroke. The most common kind--called ischemic stroke--happens when a blood vessel in the brain gets plugged, like a dam in a river, cutting off oxygen and nutrients from needy brain cells.

FERGUSON: The blood clot plugs the blood vessels and stops any flow beyond that plug, depriving the brain of oxygen and putting those brain cells downstream at risk for death.

So what can be done? The answer to that question is drastically different today than a couple decades ago--thanks to a synergy of new drugs, new tools, and, the foundation of it all, crystal clear, lightning fast imaging. Pictures of the inside of your head, giving doc's a roadmap for treating stroke. Techniques like CAT scans have improved dramatically--we're talking a difference of 25 minutes for a grainy image, versus, just 5 seconds for a perfect picture. Now, says Ferguson:

FERGUSON: We know exactly what we're dealing with and we know where we're going and we can do it much more quickly.

And speed matters--the quicker the plug can be opened, the more tissue can be saved. Time is brain, stroke doctors say.

Ferguson recounts his first night on the job, several decades ago:

FERGUSON: And I remember that vividly. It was a person who came in, the diagnosis of stroke was made, and I remember distinctly that patient being wheeled into a quiet area of the department and a curtain being drawn around them because there was nothing to do.

But now, that's all changed.

FERGUSON: Fast-forward, yesterday afternoon, we had two patients come in at the same time with blood clots plugging the arteries in the brain…simultaneously we treated both patients…today they're moving, talking and 30 years ago that just didn't happen. We didn't have any methodology, we didn't have any techniques, technologies or medicine to accomplish that type of outcome.

In the past decade alone, the annual rate of death from stroke decreased by 34%, and nowadays, 50-70% of stroke survivors will regain functional independence after their stroke.

Chris Duncan, a patient of Dr. Ferguson's at MetroHealth, owes his life to these advances in stroke care.

I met up with Duncan and his family at a café. Duncan is 39, fit, soft-spoken, works at Valley Ford Truck, and this summer he's been watching his nine year old son Seth light up the ice at hockey camp.

On the morning of his stroke, Duncan thought at first that he was just being clumsy, and was waiting for the caffeine to kick in.

DUNCAN: I woke up for work normal like any other day…Only difference on this morning when I went to get my coffee I dropped my coffee cup and it just seemed like I was half asleep.

But things got worse--dropping his cell phone, knocking over the microwave stand--and his wife made him go to the ER.

Acting swiftly, Dr. Ferguson imaged Duncan's brain, found the plug, and went in, delivering a clot-busting drug right at the blockage.

Duncan was awake during this whole procedure, and Ferguson says that he even called out the answer to some music trivia in the OR:

FERGUSON: To my shock Christopher, who had not been able to speak, yelled out the name of a singer. It happened to be the wrong singer, but he was on the right track--he guessed the Eagles and it was Joe Walsh.

The fact that he could speak again so quickly--this was a very good sign.

With quick action, Duncan benefited profoundly from the advances we've made in stroke care. When I asked him the difficult question of…What if the outcome had been different? What if they couldn't have helped him?.. He paused for a long moment.

DUNCAN: Wow that's tough. That's probably something I don't like to think about. That would've been really difficult for us. It would have been hard not having an income. I am pretty sure disability doesn't pay all that much.

Sitting on his dad's knee, Seth chimes in:

SETH DUNCAN: Yeah I was really sad that he had a stroke. I didn't even know how it happened.

Seth fights to keep his voice level, and his dad, holding him close, starts tearing up as well:

SETH DUNCAN: That was pretty sad.
DUNCAN: Don't you start, now. You're going to get me going.
SETH DUNCAN: I mean, whooh.

FERGUSON: I've been fortunate you could say in that my career has spanned almost the entire history of stroke treatment. And it is an interesting aspect to a career when you're able to see that much progress, that much of a change in one lifetime where we've gone from being essentially impotent to help, to seeing people fully recover from what would have otherwise, 30 years before, been an incurable devastating disease.

FERGUSON: The message is that we can help those people now.

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