When someone has a stroke, time to treatment is critical. Every minute is essential for minimizing damage to the brain and nervous system, which is why it’s no surprise that treatments often center around lifesaving, emergency surgery to unblock or repair arteries and restore normal blood flow. However, in some cases, a more conservative approach to stroke care is just what the doctor ordered.
Nick T., a 41-year-old single father and electrician from Milford, New Jersey is proof. After suffering a major stroke while on the job, Nick was airlifted from a community hospital to Overlook Medical Center’s Comprehensive Stroke Center. In the neuro ICU at Overlook, Atlantic Brain and Spine Neurosurgeon Kyle T. Chapple, MD carefully evaluated Nick before walking him and his family through potential paths for treatment.
“I just remember telling Dr. Chapple I needed 10 more years to see my daughter, Dylan, grow up,” Nick says. “That was the only thing on my mind.”
Nick’s MRI and MRA scans showed he had a carotid artery dissection, a tear in the inner layer of one of his carotid arteries. The tear caused a clot that completely blocked Nick’s left carotid artery, preventing blood from reaching his brain through this vessel.
Spotting the Warning Signs
“A carotid artery dissection can lead to a serious stroke – and we often see them in young, healthy people,” explains Dr. Chapple. “A dissection can happen from vigorous exercise, manual labor or even just spontaneously. That’s why it’s so important that everyone, not just older people, knows how to recognize the symptoms of a stroke.”
In Nick’s case, he began having trouble picking up his right arm while at a job with his brother. When Nick went to tell him that something was wrong, he could tell his brother couldn’t understand what he was saying, prompting him to call 911.
Arm or leg weakness and slurred speech are common warning signs of stroke. Other stroke symptoms include balance difficulties or dizziness, eyesight changes, facial droop and a terrible headache.
“If you notice any of these symptoms – at any age – don’t ignore them. Call 911 and get to the emergency room. When people who have strokes receive the right treatment, right away, the outcomes are excellent,” adds. Dr. Chapple.
Carotid Artery Dissection Treatment Options
Dr. Chapple outlined two primary treatment options for Nick’s carotid artery dissection. He could take the traditional approach of surgically evacuating the clot and putting in a stent to keep his artery open. Though a quick and effective tactic, reopening the clot immediately carried the risk that a small piece of the blood clot could break off and travel to the brain, potentially causing permanent damage.
Alternatively, Dr. Chapple could keep Nick under close surveillance and treat him with medication only, using a careful selection of blood thinners that have a proven track record of working well for carotid artery dissections. These blood thinners would dissolve the clot and prevent future clots from forming while the carotid artery healed on its own.
“I ultimately didn’t want to take the risk and trusted Dr. Chapple’s recommendation to go the more conservative route with medication,” says Nick. “Judging by my recovery, that was clearly the right choice for me.”
“As a neurosurgeon with an array of high-tech surgical tools, it’s still important to know when to take a lighter touch,” adds Dr. Chapple. “We’re in a unique position to do that at Overlook Medical Center’s highly specialized stroke center where our team of experts closely monitor patients 24/7 and are ready to go at a moment’s notice should we observe any neurologic changes that would call for surgical intervention.”
Seven days after being admitted, Nick was stabilized and released from the hospital on blood thinners. Thanks to diligent follow-up, an angiogram four months later showed full blood flow restored to the brain through his left carotid artery. Six months after the incident, Nick was physically in the clear while he continued to recover cognitively. Today, he is back to his normal self – hard at work and enjoying every possible minute with Dylan.
“I’m here for my girl, and I can’t thank Dr. Chapple enough,” Nick says.
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