The latest advance in emergency stroke treatment is now available at St. Mary's Health Care System in Athens: the ability to physically remove the large-vessel blood clots that cause the most damaging strokes.

Called mechanical thrombectomy, the procedure up to now has been available in Georgia only at a handful of hospitals, mostly in Atlanta and Augusta. Having it available in Athens will save critical time for area residents – a stroke can kill up to 2 million brain cells a minute – and may dramatically improve outcomes for many patients.

St. Mary's first mechanical thrombectomy was performed March 13 by Neil Woodall, MD, a neurosurgeon who came to Athens in 2017 from Barrow Neurological Institute in Arizona, one of the leading neurosurgical training programs in the nation.

Mechanical thrombectomy is made possible by neurointerventional biplane technology, a state-of-the-art system recently installed at St. Mary's. Using the system's advanced imaging capabilities, Dr. Woodall and other specialists can obtain images in two planes simultaneously: front-to-back and side-to-side (thus the term "biplane"). Powerful software combines these images in real time into highly detailed, three-dimensional views of internal structures. The biplane makes it possible to visualize the large vessel blood clots that cause strokes and extract them.

"St. Mary's new neurointerventional technology represents a giant leap forward in helping physicians diagnose and treat stroke and other neurological abnormalities," said Montez Carter, President and CEO of St. Mary's Health Care System. "We can now provide advanced care – on par with what patients would receive in major metropolitan teaching hospitals – right here in our community."

In addition to removing the blood clots that cause major strokes, the system can be used to repair life-threatening aneurysms – areas in blood vessel walls that become weak and can rupture.

How it works

"For appropriately selected patients with vascular disorders of the brain, an endovascular procedure can obviate the need for traditional 'open' surgery, resulting in less pain, a shorter hospital stay, and quicker recovery time," Dr. Woodall said.

St. Mary's neurointervention system combines 3D imaging with advanced catheter technology. Catheters are long, narrow tubes that can be threaded through blood vessels inside the body. Instead of a major surgical incision through skin, muscle or even the skull, catheters are inserted through a small entrance port into a blood vessel, usually in the upper thigh. The biplane's imaging system allows the physician to navigate to the problem area with pinpoint accuracy. Then, the physician can deploy a device through the catheter that grabs the clot and gently pulls it out of the patient's body.

"Strokes are commonly caused by a thrombus, or blood clot," said St. Mary's stroke coordinator Joanne Lockamy. "When a clot blocks a blood vessel, up to 2 million brain cells can die each minute, affecting everything from speech to walking. Clot removal gives us a fantastic new tool to help prevent death and long-term disability from strokes."

A new tool in the toolbox

For years, St. Mary's has been a national leader in giving patients the clot-dissolving drug Alteplase. But Alteplase must be given within three hours of the onset of symptoms and can't be given to patients with internal bleeding. Also, clots in large blood vessels – which produce the most damaging strokes – are often too big for Alteplase to dissolve. Until recently, patients who couldn't receive Alteplase – or who didn't respond to it – had few options.

Then, in 2012, the federal Food and Drug Administration approved clot retrieval devices. Stroke centers in major metro areas and teaching hospitals began developing programs to remove clots from large vessels. St. Mary's began airlifting patients who needed this level of care to Atlanta and Augusta.

In 2016, the FDA further expanded the number of patients who could undergo mechanical thrombectomy when it ruled that blood clots could be safely removed from patients who had been given Alteplase. The number of patients being rushed to major stroke centers mushroomed.  Ideally, patients would be treated closer to home, with less transport time and fewer transport risks, but the number of neurointerventionalists was small – as was the number of hospitals with the resources to acquire the neurointerventional equipment.

The next year, 2017, Dr. Woodall chose to return to the Athens community. Dr. Woodall is from Columbus, Ga., attended the University of Georgia and the Medical College of Georgia, and has extensive training in cerebrovascular and skull-base surgery. BNI, where he completed his cerebrovascular fellowship, is recognized as one of the nation's most prestigious neurological institutions.

At the same time that Dr. Woodall returned to Athens, St. Mary's Foundation launched an $800,000 capital campaign to raise funds to partially offset the cost of the biplane system. The campaign was a success, and the equipment was installed in late 2017.

Mechanical thrombectomy is available at St. Mary's anytime Dr. Woodall is available. At other times, patients will continue to be transferred to other facilities, as appropriate.

Signs of a stroke appear suddenly and can include sudden weakness, especially on one side of the body; trouble walking, talking, seeing, standing or understanding; or a severe, unexplained headache. When in doubt, think FAST:

• Face drooping

• Arm weakness

• Speech difficulty

• Time to call 911