Stroke of Genius
Doctors later discovered that Heather, only 28, had suffered a massive stroke—a disruption in the flow of blood carrying oxygen and nutrients to the brain, often caused by a clot. Strokes are the No. 3 killer of adults, but thanks to a revolutionary new device that looks like a miniature corkscrew, Williams is one stroke victim who's making a remarkable recovery. Called the Merci Retriever, the tiny instrument was introduced through an incision in her groin, then threaded through arteries to her brain, where doctors used it to remove a cylindrical clot as if clearing out a clogged pipe. Of the 141 patients who have received the treatment so far, about half, like Williams, have had the flow of blood instantly restored to their brains. "At this stage, the device is the most advanced we have to treat stroke," says Chelsea Kidwell, a neurologist and stroke expert who has not used the device herself.
Until now, the best tool available for treating brain clots has been injection of the drug tPA, which dissolves them. But it must be administered within three hours of the stroke's onset—even though patients often arrive at the hospital 12 hours after their strokes have occurred. With the Merci (short for Mechanical Embolus Retrieval in Cerebral Ischemia), neurologists hope to push that time to eight hours, expanding the window between onset and treatment that can save patients from severe brain damage or death. "That's the revolutionary part," says Dr. Pierre Gobin, of New York Presbyterian Hospital, who invented the device.
Heather Williams is a case in point: After a paramedic diagnosed a stroke at her home in Paola, Kans., it took two hours for her to arrive by helicopter at St. Luke's stroke center in Kansas City. Doctors there discovered a clot that completely blocked the carotid artery at the base of her brain. Neuroradiologist Thomas Grobelny solemnly told John his wife's "chances of living were slim to none." The family consented to use of the Merci Retriever, then in the final stages of testing prior to FDA clearance in August. Williams was placed on a movable table where a technician, guided by Grobelny, took fluoroscopes, or moving x-rays, that showed the site of the clot. Watching the images, Grobelny threaded a catheter into the large femoral artery and pushed it through the aorta and into the carotid artery to the brain. After reaching the clot, he gently torqued the retriever, broke up the clot and pulled it out.
Following the 1½-hour procedure, Heather's family—told that she still had only a 10 percent chance of survival because of the risk that her brain might swell—was allowed into her room. "I expected to see her in a vegetative state, but she was lying there with a twinkle in her eye," says her mother, Linda Evans. In the end Heather never developed swelling. Two days after surgery, she took her first post-op step, and the following day—after being coaxed by a speech therapist to count to three—she blurted, "Get my husband so I can tell him how much I love him!"
Eight months later Heather has resumed cooking and shopping, and she can drive a car. But her rebound has not been easy. "I was like a 5-year-old all over again," she says. Because of subtle damage to her brain, she is sometimes less inhibited than before, approaching strangers at the mall to tell them her story. For her husband, John, that seems a small concession. "She's more carefree now, and even childish at times," he says. "But it really doesn't bother me. I'm just lucky that she's here."
By Susan Schindehette. Giovanna Breu in Kansas City