“I thought strokes only happened to older people,” says Valerie Sanders, 26, of Whitwell, Tennessee.

 

Valerie now knows that isn’t true. On February 1, 2007, she suffered a stroke and lost the ability to speak or move on her right side. Her devastated family could barely comprehend what had happened to this bright and happy young woman. Would she survive? What kind of life could she have? How would she raise her small daughter? The situation felt bleak.

 

Fast forward three weeks, and Valerie’s miraculous recovery was being praised by President George W. Bush from a stage at the Chattanooga Convention Center, his words sent around the world by internet and satellite.

 

How did Valerie go from stroke victim facing an uncertain future to a positive presidential spotlight? The answer lies with skilled physicians and a program at Erlanger dedicated to exploring the latest technologies and treatments for stroke.

Stroke is the third leading cause of death in the United States. 83% of strokes are ischemic, meaning they occur from the blockage of a brain artery. Brain cells are huge consumers of oxygen and glucose. When a blood clot cuts off these supplies, as happened to Valerie, brain cells can suffer damage within minutes.

 

The most effective treatment for stroke used to be a clot-busting drug known as tissue plasminogen activator or “tPA.” The drug has to be administered intravenously within three hours of the onset of stroke symptoms or the drug’s effectiveness is outweighed by dangerous side effects. If introduced directly into the clot through an interventional approach, the drug can be used effectively within six hours of the onset of symptoms. With this short window of time to start tPA, fewer than 5% of stroke victims receive the drug.

 

“Before tPA became a treatment option, all our attention was focused on rehab and preventing future strokes,” notes Tom Devlin, M.D., a local neurologist and medical director of the Southeastern Stroke Center at Erlanger.

 

But Dr. Devlin and Blaise Baxter, M.D., a local interventional radiologist, have been at the forefront of research and clinical trial into new methods of treating stroke. Tennessee has the third highest incidence of stroke in the nation. Over 900 stroke patients were treated at Erlanger last year. As Dr. Devlin says, “While this is not good news for our area, it makes us a prime location for the development of new treatments.”

 

In recent years, innovations researched by the stroke team at Erlanger have included a powerful clot-busting drug derived from the saliva of vampire bats; a “Cool-Aid” treatment during which a chilled catheter inserted into the femoral vein cools the blood as it flows to the brain to limit the extent of injury; and a thin, wire-mesh tube, called the “Wingspan stent,” that is designed to unclog arteries by popping open inside the fragile blood vessels of the brain.

 

Valerie was a perfect candidate for another procedure - the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retriever, a tiny device that removes a blood clot from a blocked artery. 

 

During the MERCI retriever procedure, an interventional radiologist guides a tiny corkscrew-like device into the blocked brain artery. Interventional radiologists are doctors who are specially trained in imaging techniques to view the inside of the body as they guide small instruments through blood vessels to the site of the problem.

 

Dr. Baxter notes, “No head incisions are necessary with this minimally invasive therapy. The MERCI retriever is introduced into the body through a small puncture site in the groin and threaded up through the arteries with a catheter.

 

“Once the retriever reaches the target area in the brain, the nickel-titanium coil is placed in the clot. The retriever forms its corkscrew shape in the blocked brain artery, allowing it to capture the clot. As the device is withdrawn, the clot is removed and blood flow is restored.”

 

Cleared by the Federal Drug Administration in 2004, the MERCI retriever has been in use at Erlanger since clinical trials. Last summer, the MERCI retriever was used to remove a two and half inch clot from the brain of a Georgia man. Dr. Devlin believes the size of that clot to be a record and adds that the man was back to his work and family within weeks of the procedure.

 

For Valerie Sanders the outcome has also been good. In a video presented to President Bush during his visit to Erlanger on February 21, 2007, Valerie was seen in the hospital not long after her stroke, struggling to speak, move or respond to directions from Dr. Devlin. After the MERCI catheter removed a clot from her brain, another video showed talking, laughing, and telling the world, as President Bush proclaimed in his Convention Center presentation, “How happy she was.”

 

Her happiness continues. At press time for this article, Valerie had passed a test at Siskin Hospital for Rehabilitation that cleared her to resume driving. Her hope is to return to work as an insurance claims adjuster. Dr. Devlin notes that a few short years ago Valerie’s outcome would have much different. After intensive therapy, she might have been in a nursing home, dependent on others for the most basic of human necessities. Instead, she is making steady progress back to a normal life.

 

No one, single therapy can work for all patients, but the MERCI retriever represents a major breakthrough. Drs. Devlin and Baxter say more innovations are on the horizon. Erlanger has a strong commitment to the program, having invested in a new radiology suite designed just for high tech work such as the MERCI retriever.

 

Research and technology comes with a high price tag. Raising money is a focus for both doctors through their work with their Pleiades Foundation for Advanced Neuromedical Education. Dr. Devlin states, “New procedures and devices are not always covered by insurance plans, so funds are needed to cover some of these costs.” More information about the Foundation can be found at www.pfcme.org.

 

Dr. Devlin also hopes to attract new physicians to join him and Dr. Baxter in the exciting work they are doing for stroke patients in the Chattanooga area. He says, “Amazing recovery stories, like Valerie’s, should become routine.”

 

From stroke victim to the subject of presidential scrutiny, Valerie Sanders is grateful for the wonders of science and the exceptional care she has received at both Erlanger and Siskin Hospital for Rehabilitation. Most of all, she is thankful for having a future full of hope.