Linda’s life in Evanston, Wyoming was exactly what she wanted: a slower pace in a small town where she and her husband could raise their three boys. They moved to Evanston more than 30 years ago and never wanted to leave. After she retired early at age 58, she found plenty of time to enjoy her small town, her garden, and six of her eight grandchildren who live nearby.
But that small-town charm could have been dangerous for Linda late last year when, at just 64 years old, she had a stroke. Her husband was out walking the dog, and she was doing some household chores when she remembers falling. But she wasn’t quite sure what caused the fall. She stood up and almost immediately fell down again. She tried to get to the phone on a nearby table but never made it and passed out.
When her husband got back about two hours later, he was worried. He had witnessed someone suffer a stroke at work, so he knew the signs and immediately called an ambulance. EMTs rushed Linda to the local hospital treatment. Typical of many rural community hospitals, it only has a limited number of specialists and no stroke specialist on staff.
Fortunately for Linda, the hospital has a partnership with University of Utah Health’s Stroke Center to offer telestroke services in rural communities throughout the Mountain West. Thanks to the TeleStroke Program, when someone like Linda arrives in a rural hospital without a stroke specialist on staff, a provider from U of U Health is immediately available to evaluate them.
Linda remembers being in a hospital room with a doctor on a television monitor. The woman was talking, but Linda couldn’t comprehend anything she was saying. The U of U doctor determined she was having a left-sided ischemic stroke and prescribed tissue plasminogen activator (tPA), which is the main treatment for ischemic stroke. Timing of the medication is critical, though, as it can only safely be given for a few hours after stroke onset.
The tPA can break up blood clots blocking blood flow to the brain, increasing the chance of survival while also reducing the risks of long-term complications from the stroke. The medication has a difficult time breaking up large clots, though, so doctors would also need to perform surgery to mechanically remove Linda’s blood clots. The doctors in Evanston gave her the tPA while U of U Health coordinated an AirMed helicopter to transport her to Salt Lake City to undergo this procedure.
The helicopter arrived and transported Linda, who was in and out of consciousness, to the Stroke Center at U of U Health.
“I remember one of the nurse EMTs smiling at me on that helicopter ride and telling me I would be okay. Now I joke that the only helicopter ride I will probably ever take was one where I was barely conscious.”
When she arrived at U of U Health, Craig Kilburg, MD, was ready to perform the procedure to remove the blockage causing her stroke. He is an assistant professor of neurosurgery, specializing in endovascular and cerebrovascular surgeries.
“Linda had what we call a ‘tandem occlusion,’ meaning she had two blockages in the same vascular area, one in her neck and another in her brain,” Kilburg said. This type of stroke is not necessarily rare, but also not overly common, he added. It occurs when plaque builds up in the neck arteries, which eventually can get so clogged that they close off. A blood clot forms and moves into the brain. Multiple factors can play into ischemic stroke risk, including genetics, lifestyle factors, and diet.
When Linda arrived at U of U Health, the tPA injection had not significantly reduced her symptoms, so Kilburg and the stroke team made the decision to perform surgery to find and grab the blood clot and remove it from the artery to allow blood to flow again. Surgeons have multiple options to remove clots and can select the one with the highest chance of success based on things like the location of the clot or a person’s vascular anatomy. Kilburg successfully removed both blood clots from Linda’s neck and brain, but that wasn’t the end of her procedure.
“Unfortunately, because of the extent of the cholesterol plaque that had built up in the artery in Linda’s neck, the artery started to close back off, so we had to perform an angioplasty and stenting to open the blood vessel back up,” Kilburg said. During that procedure, he placed small balloons inside the blood vessel at the site of the cholesterol plaque and inflated them to push the excess plaque out of the way, opening the artery for blood flow again. Then he placed a stent to keep the artery open.
Despite the delay Linda had in getting to the Evanston emergency room after the onset of her stroke, and the time in the helicopter to Salt Lake City, her brain suffered very little damage. According to Kilburg, some patients have more robust “collateral channels” where blood can flow around a blockage and continue supplying the brain enough blood to avoid major damage or severe long-term effects following a stroke. He believes Linda had these robust collateral channels helping supply her brain with blood even while there was a blockage in the main artery.
When she initially woke up after the procedure, Linda did have some residual neurologic changes. Her entire right side was immobile, and she could not remember her husband’s name (although she did know they were married). Her voice was different, and when hospital staff or family members would ask questions, she sometimes had a hard time finding the right words to answer. Two days later, though, she had full use of her right hand and her voice was back to normal.
Linda did physical therapy (PT) and occupational therapy (OT) for about six weeks after her surgery to continue to improve the function in her right side, and her recovery went very well. Despite that good news, for the first few months following the stroke, she was very worried.
“If I felt something like a headache, or anything out of the ordinary, I wondered if I was having another stroke,” Linda said. “I was very afraid, but I’m totally over it now.”
At her first follow-up appointment, Linda brought a legal pad with three pages of questions.
“Dr. Kilburg sat down and answered every one of my questions...In each appointment, he says, ‘What other questions do you have?’ and always has plenty of time for me. That really helped me feel less worried.”
Linda still struggles with some equilibrium issues and occasionally forgets a word, but she doesn’t let those minor issues frustrate her. She has regular checkups with her primary care doctor and follow-up appointments with her stroke care team usually via telehealth. If she has a medical question, U of U Health nurses are also available via text or a phone call to respond, and they often answer within a couple hours.
Doctors advised Linda to change her diet and add more physical activity. She now eats a lower-fat diet and walks two to three miles a day. With a healthier future ahead, Linda is looking forward to more travel, including cruises with her husband and sister, camping in the Bighorn Mountains this summer, and a trip to Texas to visit her son and grandchildren.
She feels very lucky that the hospital in her town was one with a U of U Health TeleStroke Program. That immediate expertise from a stroke specialist and the quick treatment contributed to her recovery, and it may have even saved her life
“The collaboration between our stroke specialists and the hospitals that participate in our telestroke program is exceptional. We always say ‘time is brain’ for someone experiencing a stroke, so having quick access to doctors who can stay up to date on the latest stroke treatment is critical.”
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