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Sparing Death With the Merci Retriever
The specialist checked his watch. It was 8:45 a.m. There were just minutes left to administer tPA (tissue plasminogen activator), a clot-busting drug that's only approved for use within three hours of a stroke. But the doctor worried that the clot in Traci's brain was too big to dissolve with tPA. If it didn't work, she'd be left profoundly disabled, if she survived at all. Up to 50 percent of people with a blockage where Traci's was die.
Traci also qualified for a newer procedure, then offered at only one facility in her state: Overlook Hospital, in Summit, New Jersey. A corkscrew-like device called the Merci Retriever (FDA approved in August 2004) is designed to pluck clots out of blocked vessels like corks from wine bottles. It's more beneficial than tPA for large blockages and works for up to eight hours after a stroke, says Ronald Benitez, MD, Overlook's director of endovascular neurosurgery. "Expanding the treatment window means many more patients will be spared death or disability, since most people don't get to the hospital in time for tPA."
The Merci treatment has serious risks, including punctured blood vessels (brain hemorrhaging), which could worsen the stroke or even be fatal. And since the hospital had recently acquired the device, Traci would be only the second patient in New Jersey to undergo the procedure, which is 54 to 69 percent effective at restoring blood flow, according to a 2006 study at University of California, San Francisco. Faced with a life-or-death decision, and a ticking clock, Michael didn't hesitate. Scrawling his signature on a consent form, he shouted, "What are you waiting for? Let's get her moved to the other hospital!"
While doctors scrambled to make the arrangements, Michael called Traci's parents. "I hoped I'd made the right decision," he says. "I would have agreed to anything if it gave Traci a better chance at getting back to normal. She didn't seem to be suffering, but when the doctor asked her to stick out her tongue, she couldn't even do that." Michael sped to Overlook Hospital so fast that he actually beat the ambulance there. When Traci arrived, about 10 a.m., he kissed her and promised that the surgeons would help her. "I must have said 'I love you' a hundred times before they pulled me away. I was bawling my head off."
Four and a half hours after the stroke began, Traci was put under general anesthesia. Dr. Benitez threaded a tiny tube into an artery in her leg. Using x-ray images as a digital road map, he navigated through a maze of blood vessels to her brain. When he reached the blocked vessel, he squirted tPA directly into the clot, a still experimental use of the drug. "That loosens the clot up so it's easier to extract," the surgeon explains. The next step was inserting the Merci Retriever into the tube. The Retriever is a flexible wire made of metals that have "memory." When the nickel and titanium tip comes out the other end of the tube, it "remembers" to curl into a corkscrew. If all goes well, it snares the blockage when pulled back through it.
But Dr. Benitez's first attempt only captured a few fragments -- just enough to start a trickle of blood through the obstructed vessel, like water spilling from a leaky dam. Not good enough. The process was carefully repeated. "Traci's being so young and having two kids added to the urgency," Dr. Benitez says. The device was slowly extracted. To the doctor's relief, a huge clot was tangled in its coils. X-rays showed blood surging through the vessel at the normal rate. Two much smaller vessels, though, were still clogged. Dr. Benitez squirted in more tPA and they slowly regained flow, except in one tiny area. He'd done all he could to bring her back.
Soon after the 90-minute procedure, Traci could wiggle her right leg. When she saw Michael in the recovery room, around 1 p.m., her first words were, "I love you." He was amazed and ecstatic. It seemed like a miracle that she could speak so soon after the procedure. She was moved to the neurology ICU, where several anxious relatives were waiting to see her. A nurse explained after such a severe stroke, they'd have to monitor Traci's progress one day at a time. It was too soon to predict whether she'd regain all of her former abilities, even with extensive rehabilitation. Michael sat at his wife's bedside, holding her hand. "You're going to be just fine," he promised. "You're a fighter and can overcome this." Traci nodded slowly, then drifted off to sleep.
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