Advanced imaging, clot-retrieval help save stroke patients during holiday at Upstate Comprehensive Stroke Center

The Christmas feast was about to begin.

Twenty-three of Judy Klein’s loved ones were gathered in her Syracuse home. Her grandson had prepared a plate for her mother, Fannie Barber, 101. Klein’s daughter was talking with the matriarch, who was seated at the head of the table.

Barber suddenly could not speak. The right side of her face drooped into a crooked smile.

“You need to come and look at Grandma, quick,” Klein heard her daughter saying.

The Barber clan was one of nine families whose Christmas Eves or Christmas Days included stroke treatment at the Upstate Comprehensive Stroke Center.

Swarnkar (1)

Amar Swarnkar, MD

Amar Swarnkar, MD, director of diagnostic neuroradiology, and Gene Latorre, MD, medical director of the stroke service, were on duty. Along with other members of the stroke team, they were poised to care for patients with neurological emergencies during the holiday. Among the patients they cared for was Barber, who they believe is the oldest patient to undergo clot-retrieval at Upstate. They also took care of a man whose stroke was detected through a sophisticated brain scan and software program that’s only available at comprehensive stroke centers.

Alton Oherien, 40, of Oneida had no idea he was having a stroke when he awoke around 2 a.m. Dec. 24 with the worst headache of his life. He decided to try to sleep it off. Hours later when he awoke again, he stood up and lost his balance.

“I didn’t know what was going on. I just

Latorre, Julius Gene

Gene Latorre, MD

knew something was wrong,” he says. He called his sister, who lives nearby. She took him to Oneida Healthcare. In a standard computerized tomography scan, Oherien’s brain appeared normal, but his symptoms still suggested he was having a stroke. Doctors there sent him by ambulance to Upstate.Time is critical in stroke care. Normally, Oherien would be ineligible for any acute stroke treatment since he sought care more than six hours after the onset of his symptoms.

Upstate’s Comprehensive Stroke Center has state-of-the-art CT scan software that helps select patients who may still benefit from acute stroke interventions, even if they are outside of the standard time window for treatment. This allows doctors to offer life-saving treatment up to 24 hours after the onset of stroke symptoms, something no other stroke center in the region can do.

The CT perfusion imaging scan done at Upstate revealed brain tissue in jeopardy of dying. Circulation to this area, called the penumbra, was impaired and needed to be restored promptly. To do that, Swarnkar would insert a catheter in Oherien’s groin and thread it into his brain to find and remove the troublesome clot.

Oherien remembers everything. He followed instructions to stay still, and to not talk during the procedure, called a thrombectomy.

Soon after the clot was out, Oherien says he felt better. “The next day, I really got to feeling back to normal.” Three days later, he got to go home, but Oherien spent Dec. 25 easing back to usual activities. Nurses helped him out of bed to walk, and later in the day he was able to eat lunch.

While Oherien recovered from his stroke, several blocks away from Upstate, Barber was enjoying the Christmas festivities from her spot at the head of the table. A plate of appetizers was in front of her, and her grand-daughter was at her side.

“She was perfect up until that moment,” recalls Judy Klein, Barber’s daughter.

When it was clear that something was wrong, Klein wrapped her arm around her mother: Are you in pain? Can you breathe? “She couldn’t get any words out.” Klein reassured her mother. “I kept telling her, ‘you’re fine. We called 911, and they’re coming to help us.’ ”

Klein rode with Barber in the ambulance to Upstate University Hospital’s emergency department. “When we got there, the doctor and his team were at the door,” she recalls. Her mother was whisked down the hall for a CT scan.

 

One of the caregivers talked with Klein about a clot-busting medication that could help Barber, since the stroke had begun less than three hours ago. They also discussed the thrombectomy procedure Barber would undergo with Swarnkar.

Everything happened swiftly.

“Within an hour, she was back to herself,” Klein says. “Her face was straight. She could move her left arm. She could speak clearly. And she wanted to go home.”

Klein, who describes her mother as a very healthy 101-year-old, says she will undergo rehabilitative therapy before returning home. Evenso, her mother’s rapid recovery from stroke seems to Klein like something of a Christmas miracle.

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