Stroke patient grateful for receiving the “clot buster,” IV-tPA

Steve Rhyne was simply eating a snack when he had a stroke at age 58.

He noticed his hand kept missing his mouth as he tried to eat. When he stood up and walked across his house to tell his wife something was wrong, his right arm dropped to his side and “flopped around like Jell-O,” Rhyne recalls.

His wife, who had worked at a hospital, recognized the signs of a stroke. In addition to Steve’s arm weakness, one side of his face visibly drooped and he began to slur his words. By the time he arrived at UF Health Jacksonville, he was unable to speak at all. He communicated with the Comprehensive Stroke Center team by using a series of blinks to signal yes or no to their questions.

The team told him about a drug known as the “clot buster,” intravenous tPA (tissue plasminogen activator). It was sanctioned by the Food and Drug Administration as an effective treatment for ischemic strokes if delivered in the first three hours after the person was last seen normal. Additional studies have shown it can be effective as late as four-and-a-half hours after a stroke.

Rhyne gave the team permission to administer the drug on him about two-and-a-half hours after he had his stroke. Today, he is so glad he made that decision.

“I know I wouldn’t have had a very good life, even if I had just stayed the way I was when I was brought in,” he said. “I started to feel the difference right away after they gave me the drug.”

He found out the stroke was caused by a 95 percent blockage in his carotid artery. Once he recovered from the stroke, he returned to the hospital to have the blockage removed.

Eliminating clots

A clot in a blood vessel no thicker than an eyelash is enough to cause a stroke. As blood no longer flows to the blood vessels beyond the clot, brain cells are starved of oxygen and food and die at a rate of two million per minute. In images of brains affected by strokes, a black space can be seen where the cells died. Years later, that black space will still be there – it cannot be changed once the cells die.

Delivering tPA is the ideal treatment for patients who reach the hospital early enough after an ischemic stroke. But sometimes patients have a stroke in their sleep and don’t realize anything is wrong until they wake hours later. Other times, it takes the patients and their families a long time to realize what has happened. They may not arrive at the hospital until after the timeframe to deliver tPA has passed.

In facilities that have more limited resources to treat strokes, patients who arrive too late may have no choice other than to begin adjusting to the debilitating effects of their stroke. Fortunately, at a Comprehensive Stroke Center, which has the highly-trained staff and cutting-edge equipment to treat more advanced stroke patients, there are still options.

For example, UF Health Jacksonville’s team can remove clots through the blood vessels with a stent retriever. They use a tiny wire inserted into a large blood vessel in the thigh–the femoral artery–to find the clot. The wire can extend all the way through the artery to the brain. Once it reaches the clot, the end of the wire can be expanded into a wider stent that can “grab” the clot and pull it out of the blood vessel. A suction or a balloon-like device can also be used when necessary to ensure the clot doesn’t leave any “debris” behind.

Explaining the process one day in his office, University of Florida College of Medicine – Jacksonville cerebrovascular neurosurgeon Lincoln Jimenez, MD, an assistant professor of neurosurgery, held up a tiny wire to demonstrate.

“Once we reach the clot, the wire advances further into the artery,” he said, manipulating the wire until a spiral-shaped coil – the stent – appeared to bloom out of the end of the wire.

He displayed a photo on his computer screen that showed a similar coil with bright red chunks of blood embedded in it.

“Everything comes out,” Jimenez said.

He clicked through to images showing a patient’s blood vessels before and after a clot was removed. The first image showed a dark area beyond the clot. The second showed a bright network of vessels that began circulating blood again once the clot was removed.