Stroke survivor Noah Henley of Salisbury, North Carolina, doesn’t mind his neurosurgeon likening him to a kitchen sink. That’s because Henley is alive and well enough to appreciate the analogy.
“Let me make it as simple as possible,” said Dr. Ziad Hage, of Novant Health Brain & Spine Surgery- Cotswold. “You’re doing plumbing on a human being. You’re opening a pipe. Imagine that pipe being in a human being’s brain.” And then imagine an immense blockage that can kill or disable the person.
Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled. Thanks to fast, expert care, Noah wasn’t one of the casualties. His story about how a procedure called a thrombectomy saved his life is a journey to share during National Stroke Awareness Month in May. As his wife, Mary, says, “I think Noah’s case was a miracle, that everything happened like it did.”
Stroke prevention starts with a doctor's visit.
Noah, 71, spent much of his career teaching anatomy and physiology at Rowan-Cabarrus Community College. After retiring from there, he continues to teach as an adjunct faculty member at Catawba College in Salisbury. He and Mary have four adult children, four grandchildren and two great-grandchildren. Noah suffers from diabetes and high blood pressure, two risk factors for stroke. That was the furthest thing from his mind on Dec. 21, 2022.
That evening, they gathered at El Patron Mexican Grill & Cantina in Salisbury to celebrate their great-niece’s 16th birthday. After dinner, they got in the car and buckled their seat belts. It was 8:38 p.m. Mary said something to Noah. He didn’t answer. She took his left hand and squeezed it. “It felt like a dead fish.” “When he looked at me, the whole left side of his face was drooping.”
At the time, Mary was working as a nurse practitioner (she is now retired), another piece of blessed fortune in a saga filled with them. One word leaped to her mind. Stroke.
She drove Noah crosstown to Novant Health Rowan Medical Center, arriving at the emergency room at 8:50 p.m. Five staffers, including nurses, came out and rushed him inside. They took his blood pressure (it was high), reviewed his medical history and did a CT scan to locate the clot. A neurologist reviewed the case via telemedicine. He ordered medication to lower Noah’s blood pressure, gave him medicine commonly called a clot-buster and ordered a second CT scan to see if the clot had dissipated. It hadn’t.
They placed him in an ambulance – the weather was too bad for a helicopter – and drove the 40 miles to Novant Health Presbyterian Medical Center near uptown Charlotte. They arrived sometime around midnight. Mary and their children joined him soon.
Hage was about to perform a thrombectomy to resume blood flow to the brain.
Hage is head of cranial neurosurgery for Novant Health’s greater Charlotte region. He is one of four neuro-interventionalists who performs thrombectomies – also known as an endovascular thrombectomy, or EVT.
The procedure has only been around since 2010. Today, some 60,000 are performed each year in the United States. In the Charlotte area, Novant Health performed more than 120 thrombectomies. Hage did nearly 30. Noah was lucky enough to be close to a major metropolitan hospital. Although the procedure is common, a recent New York Times story pointed out that it’s still not widely available in parts of the world.
Only 10% of stroke victims are eligible. Factors include a patient’s age and general health; location of the blockage; length of time since the “last known well sign” as doctors put it. If it’s been less than 24 hours since the stroke, it’s a go. The speed with which the Henleys responded made Noah a great candidate, and a great role model for stroke victims everywhere. Bleeding in the brain is an automatic disqualifier. Stroke victims who aren’t eligible are treated with medicine and physician and family support and counseled on lifestyle issues such as diet, exercise and stress.
Thrombectomy in action
There are many variations on devices that help neurosurgeons perform thrombectomies. This animated video from Medtronic is a one example of how the procedures work.
The surgery takes 10 to 15 minutes. The patient is awake but under moderate sedation. Noah said he remembers the ambulance ride to Charlotte but not the procedure.
Hage describes what happened next: “We accessed the patient’s artery in the right groin with a needle, through which we introduced a catheter that served as our highway from the groin to the brain. Another smaller catheter was introduced through the first one and brought up to the level of the blood clot. A metal device was then advanced through that catheter and deployed within the clot to grab it. Then the clot was retrieved back into the catheter. It was placed under suction, effectively acting as a vacuum, therefore removing the clot and re-opening the vessel. The procedure went smoothly and was a great success.”
Going back to Hage’s initial plumber analogy: He ran a catheter all the way from the groin to the brain and pulled out the clot in minutes.
Not that Hage’s explanation requires confirmation, but with a pride and relief in her voice, Mary said, “That’s how it happened.”
By 1 a.m. Noah was out of surgery and recovering in the neurosurgery ICU. Seven days later, he was moved to Elizabeth C. Stanback Rehabilitation Unit, located at Novant Health Rowan Medical Center. He spent 21 days there working on physical and occupational therapy.
On Jan. 18, 28 days after the stroke, he returned home to “Welcome Home Noah” signs in the yard. His speech is good. He has minimal weakness on his left side. He uses a walker, partly due to a bum knee. He can’t drive but is eager to. He tires easily, but Mary said that’s not unusual. Before the stroke, he’d doze off in his recliner. Noah continues to work hard at physical therapy and is making great progress. He has an upbeat outlook on life and still is eager to talk about science with anyone who will listen.
Noah and Mary have seen the clot from the original CT scan. He’d love to have the actual clot, an inch-long mass of jelly, basically.
“I want to have it in a specimen jar to show my students,” he says.
All in all, Mary says they feel blessed to be here. She credits their swift response that evening outside of the Mexican restaurant. The care they received in Salisbury and Charlotte. And the procedure that unclogged Noah’s “pipe.”
1-minute medical lesson
- Stroke is a condition where the blood supply to the brain is disrupted, potentially resulting in oxygen starvation, brain damage, loss of function or death. It is most frequently caused by a clot in an artery supplying blood to the brain.
- Strokes are the second-leading cause of death worldwide behind heart disease, according to the World Health Organization.
- Warning signs include difficulty speaking and swallowing, confusion, loss of vision and balance, sudden numbness or paralysis in the face, arm or leg, especially on one side of the body, sudden and severe headache, and vomiting.
- High blood pressure, high cholesterol, smoking, obesity and diabetes are leading causes of strokes. Family history and lifestyle can also be factors.
- A swift response is critical, hence a familiar acronym in the medical world, Act F.A.S.T. F: Face. Ask the person to smile. Does one side of the face droop? A: Arms. Ask the person to raise both arms. Does one arm drift downward? S: Speech. Ask the person to repeat a simple phrase. Is the speech slurred or strange? T: Time. Call 911 at the first sign.