Innovative stroke therapy provides miracle results

Mailis Toop wasn’t concerned about the pain she felt in her neck when she arrived for class at Kirkwood Community College on a Friday in April 2015.

Before long, however, that discomfort gave way to a nightmare scenario: The 29-year-old exchange student from Estonia had a stroke in the classroom. A blood clot that had formed in a damaged artery in her neck had moved to her brain, depriving it of oxygen.

Successful stroke treatment requires split-second decision-making. If left untreated more than a few hours after the onset of symptoms, stroke can lead to death or severe, lifelong disability.

Mailis was disoriented, paralyzed, and at times unable to speak. She was thousands of miles away from her home and family.

Despite those dire circumstances, Mailis was fortunate for several reasons. Her teacher, her classmates, and her host family acted quickly. Before the day was through, her life was saved—by a groundbreaking treatment called thrombectomy—at University of Iowa Hospitals & Clinics, the only facility in Iowa that offers the procedure.

A trip to the hospital was far from Mailis’s mind that day. She felt healthy. She liked to run, and she had recently added weight training to her exercise routine. She assumed the pain in her neck was just workout-related soreness. So she was bewildered when her vision started doing strange things during her class.

“It’s really hard to explain,” she says. “I couldn’t see the professor standing in front of me. I could only see to my left. Then, seconds later, I felt like something else was going on with my head. I told the professor that I might need a doctor.”

Her teacher and classmates wasted no time. They called 911 and stayed by her side.

“I’m really glad it happened at school, not when I was driving or on my own somewhere,” Mails says. “I got help right away.”

Her condition worsened in the short time it took the paramedics to arrive.

“They had my driver’s license, and they couldn’t figure out how to pronounce my name,” Mailis says. “I wanted to tell them the correct pronunciation, because that’s what I always do, but I couldn’t speak. I understood every question, but I couldn’t respond. I couldn’t control my body at all.”

Mailis (pronounced “my-leece”) was rushed to UI Hospitals & Clinics. Although she couldn’t speak for herself, there was someone there who could speak for her: Jason Wilbur, MD, her student-exchange host father. A UI family medicine physician at the hospital, Wilbur arrived in the emergency room not long after Mailis did, and he was able to consult with the ER care team on her behalf.

That team included neurointerventionalist Santiago Ortega, MD—another point in Mailis’s favor. Ortega was one of two doctors on staff who could perform a thrombectomy.

“When she arrived here, she was starting to deteriorate,” Ortega says. “After a few minutes, she was barely able to breathe on her own. We rushed her into the OR and started the thrombectomy immediately.”

In a thrombectomy, a catheter is inserted into an artery near the patient’s groin. Guided by X-rays, doctors locate the brain clot, navigate the catheter to it, and introduce a wire cage called a stent-retriever. This device expands inside the artery to grab the clot and pull it out, quickly restoring blood flow to the brain.

“We were able to open the artery in 34 minutes,” Ortega says. “By the next day, she only had a little bit of numbness in her leg. It was unbelievable. We definitely felt like we saved a life. It was like a miracle.”

In 2015, the American Heart Association issued a strong endorsement of the procedure in certain severe cases of stroke. Its adoption marks the first major advance in stroke treatment in nearly 20 years.

“It’s an important message that this therapy is available for Iowans who could benefit from it. We are currently the only place in Iowa that can offer this treatment,” Ortega says.

As home to a nationally designated Comprehensive Stroke Center, UI Hospitals & Clinics has the infrastructure and personnel to offer thrombectomy to patients 24/7 as needed. In the time since the therapy was endorsed last year, four more doctors with expertise in the procedure have been recruited to join the staff.

“We are pushing hard to be pioneers in this field,” Ortega says.

For Mailis, the UI’s commitment to the new therapy means she was out of the hospital in four days and, after some rest, back in class within weeks.

“I feel fine, like it never happened,” she says. “I had my stroke in April, and my summer semester started in May. I’m graduating in spring of 2016 from the medical assistant program.”

And she remains active, having completed “a couple of 5Ks and a 10K” since having her stroke.

“I see life a little bit different now,” she says. “I’m really lucky. I keep telling that to everybody.”