Rebeca de López had just undergone a heart test and returned to her Miami hotel to rest. Her sons decided to go shopping while she ate and watched TV in her room.
“Suddenly, I started to slide off the chair. I felt strange, like I could not move and heavy on one side. I had problems swallowing,” recalled de López, a 70-year-old Guatemalan woman. “I did not think there was anything wrong. It just seemed odd that one of my arms did not respond.
“When I went to the bathroom, I slipped, but I did not fall. I tried to take off my pants, and then tried to put them back on because I could not move on one side. I never thought to call the front desk or the ambulance, not even my children. Then I managed to get on the bed, and cover myself with a towel from the bathroom.”
The standard time to treat a stroke with medication is 4.5 hours from the start of the event. After that, most hospitals do not perform surgery because of the increasing risks.
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For every minute a stroke victims spends without treatment, one million brain cells die. If the patient does not die, he or she may wind up paralyzed, with brain damage and perhaps a lifelong need for assistance for simple activities such as going to the bathroom.
De López spent the first three hours of her pain alone, until her children returned and called an ambulance.
“Sadly, the hotel elevator was not big enough to fit a regular stretcher and they had to get one that turned into a chair. So we left the hotel almost one hour after we dialed 911,” de López said.
The paramedics took her to Mount Sinai Medical Center in Miami Beach, which has a center that specializes in treating strokes, the Harvey R. Chaplin Family Stroke and Chest Pain Center.
“Our neuroendovascular surgery team uses advanced scanner technology to evaluate patients with major strokes,” said Dr. Ryan Dahlgren, a neurovascular surgeon at Mount Sinai. “With these imaging techniques we can evaluate patients with brain hemorrhages on an individual basis, focusing on the unique neurovascular anatomy.”
On arrival at the hospital, de López was seen immediately by the head of the emergency team. He spoke with a cardiologist and she underwent a brain scan.
Then the family got the news. The bad news was that she was losing all her abilities and could wind up unable to speak or take care of herself, an invalid for the rest of her life. The good news was that the hospital had a team that could try to reverse the problem.
Dahlgren explained that since she had the stroke many hours ago, he would have to do surgery to try to reverse the damage. She ran the risk of dying during the procedure, he told them, but without surgery she was dying.
“Rebeca's stroke, although devastating, had not yet caused permanent damage to the brain. We had the chance to restore blood flow to her brain,” Dahlgren said. “Because of that, we had the chance to … save her from a stroke that was severely weakening her and putting her life at risk, despite the many hours that had passed since her first symptoms.”
When a patient arrives at a hospital with a brain hemorrhage that happened less than four hours earlier, the standard treatment is to administer a medicine known as tPA — tissue plasminogen activator — to dissolve the blood clot, Dahlgren said. But tPA cannot be used after four hours because it can cause more brain hemorrhaging.
“What we did with her was a surgical neurovascular thrombestomy, using mechanical extraction techniques to remove the clot that was blocking the flow of blood to the brain,” Dahlgren said, explaining that this is done by accessing the clot with a series of tiny catheters and microwires.
“When we get past the clot and deploy a removable stent, that's when we suction the clot out of the neurovascular system,” he said. The surgery is quick; the whole procedure last about 20 minutes.
De López’s case represents a breakthrough, because she did not receive the specialized treatment until seven hours after her stroke. Thirty-six hours later, a bright and happy woman, chatty and with make-up on, was filmed by her children moving her arms and legs in her hospital room.
“Dr. Dahlgren gave us a lot of his time during my eight days in the hospital,’’ de López said. “He took all the precautions so that this would not happen to me again.”
Today, de López leads a life just like before her stroke.
“I am independent. I drive, and my fine motor skills are very good and allow me to paint, which fascinates me,” she said. “I am living again.”