Stroke doctors use suction

Tiny ‘vacuum’ clears blood clots in the brain

Shane Neufeld owes his life to a team of doctors and one of the most high-tech ‘vacuums’ in the world.

The Calgary stroke team, based at Foothills Medical Centre, inserted a tiny vacuum, called a Penumbra, through a tube and into Neufeld’s brain, where it made contact with a blood clot, broke it up and sucked it out.

“If it wasn’t for this procedure, I would have been dead for sure,” says the 36-year-old Langdon resident.

Neufeld’s procedure took place in March 2009, shortly after Calgary became the first centre in Canada to receive this piece of cutting-edge equipment.

Since then, the Penumbra has been used on almost 30 patients. It provides an alternate treatment for stroke patients whose blood clots do not respond to intravenous, clot-busting drugs.

Strokes occur when a blood vessel within the neck or brain is clogged or blocked and blood cannot flow normally.

“Devices, such as the Penumbra, can help us take care of patients who have had big strokes and give them a chance to go back to normal life,” says Dr. Mayank Goyal, a Calgary neurointerventionalist who uses the Penumbra. Neurointerventionalists perform minimally invasive therapy on the brain.

Today, Neufeld plays baseball and volleyball and takes care of his children, ages 3 and 1.

Just over a year ago, he was fighting for his life after collapsing in his home office. By the time he reached hospital, he lost vision in his left eye and couldn’t speak or move his right side.

Foothills staff quickly recognized Neufeld had suffered a stroke. Soon, the Calgary stroke team inserted a tube into Neufeld’s groin and threaded it through arteries in the abdomen and neck into the affected area of Neufeld’s brain. The Penumbra travelled through the tube and sucked out the clot.

“He had a big blockage in his brain and we got it open very quickly as a result of this Penumbra,” says Goyal.

“From where Shane started, it’s unbelievable where he is today. At first we thought he was going to die. Then we thought he would have to be in a nursing home for the rest of his life. Now he’s leading a normal life.”

With stroke, patient outcomes usually depend on how quickly treatment is administered following the onset of stroke. This holds true for Penumbra. Calgary remains the only Alberta centre with this technology.

Goyal and the Calgary stroke team recently examined data from around the world and discovered most patients do well if a computerized axial tomography (CT) scan showed minimal brain death and the clot was cleared within five hours of onset.

“If the CT scan already shows significant brain death or you don’t work fast enough, then the patients don’t do that well,” Goyal says.

He presented the team’s findings June 8 to the National Stroke Conference in Quebec City.

Goyal is now working on developing an educational website to help stroke doctors get better at interpreting CT scans of these patients.

“This is a message to the rest of the world: If you look at the CT scan carefully and work fast, you have a high likelihood of a good outcome,” he says.

The Calgary stroke team, consisting of four neurointerventionalists and eight stroke neurologists, provides stroke care 24 hours a day, seven days a week.