Back in the Flow : Stroke Victim Recovers Quickly After Experimental Treatment
He hit the garage floor hard but didn’t feel the impact. Sixty-year-old William Boyer was having a stroke, and the left side of his body had gone numb. Unable to speak or move for several minutes, he eventually managed to cry out a few garbled words. By chance, a neighbor heard.
Boyer, owner of a family-run carpet business, was taken by ambulance to UCLA / Olive View Medical Center in Sylmar, where doctors told him about a groundbreaking experimental stroke treatment that could restore the use of his paralyzed left leg and hip if it were done within eight hours of the onset of the attack.
UCLA is the only place in the country where the U.S. Food and Drug Administration is allowing clinical trials of the new procedure, and doctors there say that if experiments are successful, the treatment could help up to 80% of the estimated 550,000 people in the United States who suffer stroke-related disabilities each year.
Other neurosurgeons say the procedure sounds promising, in part because there is no standard stroke treatment yet available.
About 155,000 people die of stroke each year, according to the National Stroke Assn.
“Stroke is the No. 1 cause of adults being admitted to hospitals and nursing homes,” said Rachelle Trujillo, the association’s communications director. “When people have heart attacks, they either live or they die. With stroke victims, if you don’t die, you very likely end up with a disability.”
The UCLA procedure interested Boyer, but there was a problem: He needed to get quickly from Sylmar to the UCLA Medical Center in Westwood, but no ambulances or helicopters were available.
“That’s where I came in,” said Boyer’s wife, Pauline, who drove her husband through evening rush-hour traffic to the medical center. There, doctors warned the Boyers that only one other patient had undergone the procedure, which uses catheters, or thin, aluminum tubes, to transfer oxygen-rich blood from the femoral artery in the groin area through the jugular veins to the brain.
Most strokes occur when clots lodge in arteries in the brain, preventing oxygen from getting to brain cells. Such blockages can occur when the walls of arteries become lined with fatty deposits. Another common type of stroke occurs when the bloodstream carries a clot, often from a diseased area of the heart, to an artery in the brain where the clot gets stuck.
As with all invasive surgery, doctors told Boyer, there were risks, including potential loss of life. But the new treatment--called Retrograde Transvenous Neuroperfusion--had worked well on the first patient several months earlier, said Dr. John Frazee, the UCLA medical professor who has conducted neuroperfusion research at the university since 1987.
Still, Boyer hesitated. “I thought: ‘Should I do it or not?’ ” he said. “I knew I didn’t want to live in a wheelchair. And I’m a golf nut, and wouldn’t be able to play anymore. . . . Dr. Frazee told us: ‘If you have any doubts at all, don’t do it.’
“We almost didn’t. But then I asked him: ‘Doctor, if you were in my position, would you do it?’ He said: ‘Definitely.’ And we did it.”
After administering a light sedative, doctors inserted a catheter into an artery near Boyer’s groin and used a computer-controlled pump to draw blood out. Two more catheters were inserted in Boyer’s neck, one into each jugular vein.
“The pump passes [oxygen-rich] blood through the catheters . . . which are passed up into the back of the head” to an area called the transverse sinuses, Frazee said.
The procedure is innovative because it pumps blood into the brain “through the back door,” against its normal flow, Frazee said. “It’s pumped up the catheter and passes into the brain tissue at risk, irrigating it with oxygenated blood, which is exactly what the brain needs. Then, it passes back on to the heart,” back down the jugular veins.
The idea is to keep brain cells alive and buy time so doctors can figure out how to break up the blockage.
In Boyer’s case, something unexpected happened as the oxygenated blood was pumped into his brain. Frazee said: “We think the back-flow probably washed out the little clot that was blocking the artery. It was something we had not foreseen, but it made sense.”
After 15 minutes of treatment, doctors asked Boyer to try to move his left leg. Boyer wiggled his toe, and doctors knew the experiment was working.
Two days later, Boyer was up and walking, and 10 days later, “I played nine holes in a light rain,” he said. “My wife could have killed me, but I was fine.”
He went back to UCLA for a checkup and is taking a blood-thinning medication, but otherwise, no follow-up treatment was required, doctors said.
The procedure also worked on the first try in September, doctors said. George Burdick, 67, of Rancho Santa Margarita, was being treated at UCLA for liver cancer when he had a stroke.
Like Boyer, Burdick lost feeling on the left side of his body, said Dr. Xia Luo, assistant director of the UCLA neuroperfusion program. Burdick agreed to be the first patient to try the new treatment.
“I figured, nothing ventured, nothing gained,” Burdick said. “I didn’t want to be paralyzed the rest of my life.”
Thirty minutes after the treatment began, he regained movement in his left hand, and three months later, Burdick, an engineer, was back at work.
Frazee said his research was privately supported by an Irvine medical firm, Neuroperfusion Inc., which has provided about $700,000 since 1987. Frazee said he is not a board member or investor in the firm. The company hopes to profit from sales of the microprocessor controlled pump and catheter system developed for the procedure, Frazee said.
Several years of tests were conducted on primates at UCLA before doctors felt confident enough to try the procedure on humans, Frazee said.
Frazee said FDA officials told him the new treatment must work safely with 10 patients before it could be offered at other medical centers.
Dr. Richard Fraser, chief neurosurgeon at New York Hospital-Cornell Medical Center and a board member of the National Stroke Assn., said he first heard about UCLA’s neuroperfusion research just six months ago.
“The class is still out on this one,” Fraser said. “It’s not being done anywhere else. But as you know, there’s no good treatment for stroke available anywhere right now. So any advantage to making nerve cells live in a good environment is a step up.”
Fraser said if UCLA researchers successfully perform the new treatment on 10 patients “and get good results with no horrible complications, then I think you’ve got something.”
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New Treatment for Stroke
The new treatment--called Retrograde Transvenous Neuroperfusion--pumps blood into the brain tissue at risk “through the back door,” against its normal flow, irrigating the tissue with oxygenated blood, which is exactly what the brain needs. The blood keeps the brain cells alive and buys time so doctors can figure out how to break up the clot that has cause the stroke.
*
1. Oxygen-rich blood is taken from the femoral artery in the groin area.
2. Through catheters inserted into the jugular veins in the neck, the blood is pumped into the brain.
* Source: Times staff
