Patient Stories
At Christiana Care Health System, it is our mission and our great privilege to take care of people and help them get better.These are their stories.
‘Time is brain’ rings true for stroke patient
Elizabeth Van Leeuwen was enjoying dinner and a lively chat with her 29-year-old grandson — and suddenly couldn’t speak.
At the time, the 86-year-old great-grandmother from Hockessin, Del., was staying in a rehabilitative center, where she was recovering from a fall.
This latest challenge was an ischemic stroke, sometimes called a brain attack, that occurs when an artery to the brain is blocked.
“When I lost my speech, my grandson immediately knew something was wrong — and he got help right away,” she recalls.
Van Leeuwen was rushed to Christiana Hospital, where a stroke team was poised to evaluate her.
“That saying ‘time is brain’ is true,” says Mary Ciechanowski, MSN, RN, ACNS-BC, CCRN, stroke advanced practice nurse. “We work in conjunction with the Emergency Department to quickly identify stroke patients so we can determine the appropriate intervention.”
Because Van Leeuwen arrived at the ED soon after her stroke, she could be treated with tissue plasminogen activator, known as tPA, a protein that is highly effective in breaking down blood clots. Ideally, tPA should be administered no later than 4.5 hours after the onset of stroke symptoms.
Gregg Zoarski, M.D., a neurointerventional surgeon, used a Solitaire, a new tool in the arsenal of stroke-fighting devices, to remove the clot. The device was approved by the Food and Drug Administration in March 2012, less than five months before Van Leeuwen’s stroke on July 29.
“Basically, it’s a stent on a stick,” he says. “After it’s inserted into a blocked artery with a catheter, it compresses the clot and traps it. Then the clot and the stent are removed.”
In all, the surgery took 44 minutes. Van Leeuwen was headed for recovery less than four hours after she suffered her stroke.
“We are making tremendous advances in stroke treatment and positive cases like Mrs. Van Leeuwen’s are becoming more common,” Dr. Zoarski says.
The Christiana Care Center for Heart & Vascular Health provides round-the-clock minimally invasive services and treatments in a state-of-the-art neurointerventional surgery suite. The health system has one of the highest volumes of stroke patients in the region, providing treatment for more than 1,200 patients a year.
“Everything we do here is 24/7, including surgery, labs, imaging and technicians,” Ciechanowski says.
Dr. Zoarski says Van Leeuwven’s experience illustrates the importance of seeking help immediately if someone shows signs of a stroke. In addition to difficulty speaking, symptoms include confusion, sudden and severe headache, problems with balance or walking, and numbness or weakness in the face, arm or leg, especially on one side of the body.
Today, she is healthy and happy and living at home. She has recovered her speech and is walking with a cane as she builds strength and balance.
“At Christiana Care, I got highly skilled doctors and the latest and greatest in technology,” she says. “After my surgery, I got wonderful care from the nurses. Everyone I encountered was very professional — and extremely nice.”
‘I’m pretty grateful to be here’
John Hetherington, 53, of Lincoln University, Pa., is proof of the progress that has been made in stroke recovery. One Saturday in late March, he was showering, getting ready to go to his job as a marine technician, when he suddenly found himself leaning on one side of the shower.
“I thought, ‘I should sit before I fall,’’’ Hetherington says. He called to his wife, who saw that he couldn’t move his left side and told their daughter to summon an ambulance.
At Christiana Hospital, tests showed Hetherington had a right internal carotid artery occlusion, which blocked blood flow to the right side of his brain.
“It’s amazing I’m walking and talking,’’ he says. “I’m working. I went in on a Saturday, came home Thursday and was mowing grass on Friday.’’
Hetherington didn’t know he was at a risk for stroke – he hadn’t seen a doctor in years. But the brush with mortality has changed his life. He stopped smoking, monitors the fat and cholesterol in his diet, takes his medicine and no longer avoids his doctor.
“I’m pretty grateful to be here,’’ he says, crediting Christiana Care with saving his life. “Sometimes I get a little choked up talking about it.’’
When Jane Waltz went to the emergency room at Christiana Hospital, she felt silly saying she was there for a headache. But her decision to go helped save her life.
A CT scan showed that she was experiencing a subarachnoid hemorrhage caused by a ruptured brain aneurysm. That meant blood was leaking into the space around her brain because a tiny section of an artery had bulged like a blister and then bled.
“Suddenly, I had this incredible pain in my head,” Ms. Waltz remembers. “My head literally felt like it was going to explode. It was a different headache from any headache I’ve ever had, and my neck was stiff, too.”
Her condition was critical. Without immediate treatment to stop the bleeding, she risked suffering a hemorrhagic stroke, brain damage and possibly even death. So a combined neurovascular team led by neurosurgeon Paul T. Boulos, M.D., and neurointerventionalist Sudhakar R. Satti, M.D., immediately went to work to treat Ms. Waltz.
Her treatment began with an external ventricular drain to reduce the pressure that the blood was placing on the brain. During this procedure, Dr. Boulos surgically placed a plastic tube through the skull and into a fluid-filled cavity within the brain to drain excess fluid. Then Dr. Satti performed five hours of neurointerventional surgery to treat the ruptured aneurysm.
Ms. Waltz’s case was especially complicated. She experienced a rare blister aneurysm, which is a smaller protrusion of the blood vessel and more prone to rupture than the typical saccular, or berry, aneurysm.
Dr. Satti says a blister aneurysm typically cannot be repaired with open surgery. Instead, he and his team successfully treated Ms. Waltz with a stent-supported coil embolization, which is a less invasive style of treatment performed under general anesthesia.
The procedure involved cutting a small incision near the groin and inserting thin plastic tubes and wires in the femoral artery. These tubes were used to navigate through the blood vessels to the site of the rupture. To stop the bleeding, Dr. Satti placed a metal cylinder – a stent - across the base of the aneurysm and then filled the expanded artery with a coil of platinum threads. Highly advanced X-ray equipment was used during the procedure to allow the surgeon to see his work.
The small size of the blister aneurysm – which was about as tiny as the tip of a No. 2 pencil – added to the challenge of repairing the rupture. The traditional microsurgical clip to close the aneurysm with open surgery would be difficult or impossible given the size, shape and location of the aneurysm. Using the coil embolization technique alone wouldn’t work either because the aneurysm was not deep enough to hold in the metal coils. Adding the stent to the process, however, provided enough support to keep the coils in place.
Ms. Waltz is thankful that the minimally invasive surgery is available at Christiana Care. Until she underwent the endovascular procedure, she had no idea it existed.
“The level of care I received at Christiana Care was excellent, from beginning to end.” she says. “I’m so thankful to live near a big hospital that was able to provide the team of doctors I needed.”
Statistically, Ms. Waltz is lucky. Dr. Satti said typically only about 30 percent of people who experience a ruptured aneurysm will survive to one year without a major disability.
Ms. Waltz had her emergency surgery in December 2010. Today, the 41-year-old from Bear, Del., is back at her job as a reporting analyst in the technology sector.
“Everything looks great,” she says. “I’m so lucky to be alive, and without any brain damage.”
In May 2008, Linda Dill had a stroke. This is the story of her treatment and recovery. Christiana Care earned the Gold Seal of Approval™ from the Joint Commission for Primary Stroke Centers.
