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Steven Squires was reading the comics at his kitchen table on a Sunday in September when his wife Carol heard him emit a strange groan. His hands curled, his mouth hung open. Carol called 911 as Steven reeled under the effects of a stroke cutting off oxygen to his brain.
Only hours later, Steven, 72, was awake and alert at Littleton Adventist Hospital, and three days later he walked out and headed home, little worse for having suffered a type of attack that often leaves its survivors paralyzed or dead.
Steven’s saving grace was the quick work of neurologist Dr. Chris Nichols, who utilized several treatments that removed a clot from a blood vessel in his brain, minimizing permanent damage.
Newly released guidelines suggest that doctors may have far more time than previously thought — up to 24 hours — to respond to strokes in ways that can save brain tissue from irreversible damage. Littleton Adventist Hospital and St. Anthony Hospital in Lakewood are among roughly 300 hospitals nationwide equipped with a new digital imaging software, called RAPID, that enables the extended treatment window.
“This is huge,” Nichols said. “Previously we thought that we only had a few hours to take this kind of action. For people who may have had a stroke in the middle of the night or who aren’t discovered for an unknown amount of time, these new guidelines can make a lot of difference.”
The guidelines, published in late January by the American Heart Association and American Stroke Association, are based on a host of studies, including a large-scale trial led by Stanford University researchers that utilized RAPID to quickly identify affected areas of the brain.
The majority of strokes are ischemic, Nichols said, caused by a clot in a blood vessel in the brain. Doctors at Littleton Adventist and St. Anthony have several options, often used in concert, to respond to ischemic strokes: first, doctors use RAPID to interpret CT scans of victims’ brains, quickly identifying the location of clots. In many cases, doctors then administer a clot-busting drug called TPA. Next, using a device called a stentriever, doctors can insert a tube into a blocked blood vessel in the brain and use a wire mesh structure to remove a clot.
The guidelines have continually pushed the window for intervention farther out, Nichols said.
“In the past decade, we’ve pushed it from three hours to four, then six, then 12,” Nichols said. “I wouldn’t be surprised if we get to a point where we can throw out the window altogether and just be guided by the imaging.”
Nichols said that when a stroke victim arrives at Littleton Adventist, emergency physicians perform the RAPID scan, which is then sent by email to a list of on-call neurologists, allowing doctors to begin evaluating a patient’s situation while they’re still putting their shoes on.
Deciding whether to use TPA or the stentriever is still a time-governed choice, Nichols said.
“Especially when dealing with an unknown onset time, we’re looking for a reversible deficit — that is, a good amount of salvageable tissue,” Nichols said.
“That’s called a favorable mismatch. It’s still vital to recognize that a stroke is happening and get to the hospital as quickly as possible.”
Nichols said not every ischemic stroke victim will fit the criteria, but for those that do, the results can be remarkable.
“There are times people get right back up immediately,” Nichols said. “It’s amazing, and personally, it’s incredibly gratifying.”
For Carol Squires, the treatments meant the difference between a bleak and uncertain future or having her husband home to play with their grandkids.
“While we were there in the waiting room, I was thinking he might not be happy living this way, if he was paralyzed or couldn’t speak,” Carol said, blinking back tears. She said both of Steven’s parents died of complications from strokes, and their final days were spent confused and in pain.
“Steven’s parents were certainly on my mind,” Carol said. “I couldn’t believe it when I saw him in the recovery room. I was just so glad to have him back.”
Steven said he seems to have no significant long-term damage from the stroke. He said he feels thankful that everything fell into place for him.
“My wife was here, and called 911 right away,” Steven said. “The medics were just down the road. The hospital was nearby. They recognized the symptoms and had the equipment and the knowledge. “When you think about everything that came together, it’s pretty remarkable. It wasn’t just one person. It was the group.”
Steven and Carol will celebrate their 50th wedding anniversary this August. They’re planning a big party.
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