MedStar Health Blog

For many years, the number of people who were dying of strokes in the United States had been decreasing steadily. But as the Centers for Disease Control and Prevention (CDC) noted in its September 2017 Vital Signs report, decreases in deaths from strokes have either stalled or reversed in three out of every four states. Here in Washington, D.C., we’ve actually seen an increase in the number of people dying from strokes, as have 20 states.

Most strokes are a type called acute ischemic stroke. This type of stroke is caused by a blockage of blood to the brain, usually in the form of a blood clot. In the past, a clot-busting medication called tissue plasminogen activator (tPA) had been the only approved treatment for this kind of stroke since its approval by the Food and Drug Administration in 1995. This was a huge advance for stroke care, but we needed more. Now, we have a powerful procedure—with more than six level I randomized studies that support its use—that we can use alongside tPA to save more lives and brain function for our patients. It’s called mechanical thrombectomy, and it’s one of the emergency stroke treatments we offer in our Comprehensive Stroke Center at MedStar Washington Hospital Center and in the Comprehensive Stroke Center at MedStar Georgetown University Hospital.

Mechanical thrombectomy can have huge benefits to patients who have had a stroke. Not only can this procedure increase the chance that we can save their lives, but patients are much more likely to avoid some of the devastating complications that can come after a stroke, such as paralysis, being bedridden or being unable to speak.

What is mechanical thrombectomy?

Mechanical thrombectomy is a minimally invasive stroke treatment we use for large-vessel occlusions, which are large blood clots that block one of the major blood vessels that bring blood to the brain.

The CDC estimates that about 795,000 Americans have a stroke every year. Of those, about 690,000 are ischemic strokes, or those caused by blockages in a blood vessel. About 15 to 25 percent of all the ischemic strokes are caused by large-vessel blockages. That means mechanical thrombectomy could potentially help between 103,500 and 172,500 Americans each year.

This procedure has been available to patients outside of clinical trials only since 2014, but it’s revolutionized stroke treatment in that time. As researchers noted at the American Heart Association’s International Stroke Conference in February 2016, the average number of stroke patients who received mechanical thrombectomy more than doubled at hospitals nationwide in just two years.

The normal procedure for a patient who’s having a stroke is to give them IV tPA medication as soon as possible. For smaller blood clots, the medication is very effective to break them up and move them through the arteries. But for large-vessel occlusions, tPA on its own may break up the clot only about a third of the time.

That’s where mechanical thrombectomy comes in. This procedure uses a device called a stent retriever, also known as a stentriever, and/or thromboaspiration directly that we insert into an artery in the patient’s groin with a thin, flexible tube called a catheter. We thread the catheter up to the blocked artery and either suction the thrombus directly like a vacuum cleaner or open the stent retriever and remove the clot. The retriever grabs the blood clot, and we remove both the retriever and the trapped clot.

In most cases, we would start the patient on IV tPA first to begin the clot-busting process and then perform mechanical thrombectomy to finish the job. If the patient gets to us early enough, we’re seeing success rates of 70 to 90 percent in saving lives and brain function using this procedure—far higher than the 33 percent we used to see with tPA alone for these kinds of strokes.

It’s a dramatic change. You can take a patient who went from the prime of their life, and they’re paralyzed on one side of their body, unable to walk or speak when they get to us. And after this procedure, they’re back to their normal selves. That was basically unheard of before mechanical thrombectomy. It helps us give patients their quality of life back.

Why where you go for stroke treatment matters

The common expression when it comes to stroke is “time is brain,” and that’s a fact. The faster we’re able to restore the brain’s blood flow, the more likely a patient is to survive a stroke. Mechanical thrombectomy helps us fight strokes quickly and successfully.

Dr. Richard Benson and Dr. Rocco Armonda discuss a stroke case.

Unfortunately, not every hospital is equipped to provide this procedure. In an emergency, loved ones or emergency medical professionals may take a patient who’s having a stroke to the nearest hospital, which may or may not offer mechanical thrombectomy. And even if some smaller or nonspecialized hospitals do offer the procedure, they may not have vast experience with it. In those instances, the patient will have to be transferred to a comprehensive stroke center like ours, squandering minutes or even hours in transit. Providers at comprehensive stroke centers have ample experience with mechanical thrombectomy and other complex stroke treatments. We have more doctors who perform the procedure and more specially trained nurses and staff members who can assist than most small or nonspecialized hospitals.

So even though it’s critical to get the patient help fast if they’re having a stroke, it actually can save precious time to bring the patient directly to a comprehensive stroke center, rather than having to transfer that patient from one hospital to another. Mechanical thrombectomy needs to be performed within about six hours of the beginning of a stroke, but the sooner we do it, the better the outcomes. And if we give IV tPA first to help start to break up the clot, that ideally should be given within three hours of the beginning of a stroke. That means we need to get the patient to us as quickly as possible.

If you think your loved one is having a stroke, call 9-1-1 right away. With the one-two punch of tPA and mechanical thrombectomy on our side, there’s a good chance we’ll be able to save the patient and maintain more of their mental and physical functions.

Related reading: Learn how to think FAST if you think your loved one may be having a stroke.

The J. Willard and Alice S. Marriott Foundation was established with a simple but powerful mission: to give back. The private family foundation is committed to sustaining vibrant, healthy communities through support of transformative organizations. MedStar Georgetown University Hospital is honored to be among these partners.

As longtime supporters of MedStar Georgetown’s work, the Marriott family has recently deepened its investment in the physical and programmatic future of our care community. This past fall, The J. Willard and Alice S. Marriott Foundation granted $2 million to support the construction of our new Medical/Surgical Pavilion. The Foundation coupled this extraordinary investment with a $1 million Otolaryngology-Head and Neck Surgery endowment. This endowment will increase the Department of Otolaryngology-Head and Neck Surgery’s capacity to maintain technological resources and research infrastructure, as well as attract the most talented physicians and medical students from around the world.

Under the direction of Richard E. Marriott and J. W. Marriott Jr., the Foundation’s board is composed of descendants of J. Willard and Alice S. Marriott, original founders of the hospitality company that bears the family’s name. The Marriott family’s gifts to MedStar Georgetown stem from a commitment to health equity and their personal appreciation for care received at the Hospital. 

“MedStar Georgetown University Hospital has done so much to support the health of our community, including my family,” explains Richard Marriott. “We believe that every person deserves access to the kind of superior medical care we have experienced here firsthand. Through our philanthropic support, we hope to grow the Hospital’s lifesaving efforts.”

The J. Willard and Alice S. Marriott Foundation’s investment will yield tangible results. “We are deeply grateful for the Marriott family’s comprehensive investment,” says Pam Maroulis, the Hospital’s vice president of Philanthropy. “The leadership conveyed by this significant contribution to our Medical/Surgical Pavilion helps to set the tone for our $112 million philanthropy campaign.”

Bruce Davidson, MD, chairman of the Department of Otolaryngology-Head and Neck Surgery, notes that this gift will increase capacity for medical innovation. “The family’s support of our department will drive further clinical advancement that will help our patients. There is no question that we will see the impact of this generosity for years to come.”

H. Jeffrey Kim, MD, a neurotologist/otologist who specializes in ear disorders, underscores how important this investment will be to clinician training and patient care. "The generosity of the Marriotts will have significant impact on the medical education and innovative research for our next generation of otolaryngologists at Georgetown, and it will also enable us to support medical missionary work,” he says.

In addition to these most recent investments, funding from The J. Willard and Alice S. Marriott Foundation is already fueling other important care initiatives. In 2016, the Foundation made a $6 million, five-year commitment to the Early Childhood Innovation Network (ECIN). Led by MedStar Georgetown University Hospital and Children’s National Health System, ECIN works to improve the academic, physical, and mental health trajectories of Washington, D.C.,’s most vulnerable children.

Inspired by the Marriott family’s donation? There are countless ways that MedStar Georgetown patients can support our efforts to provide world-class care. Be it through gifts of time, talent, or treasure, we all have
something to give back to our community.

Visit MedStarGeorgetown.org/Contribute or call the Office of Philanthropy at 202-444-0721.

Visit BuildingMedicalExcellence.com for specific information on the new Medical/Surgical Pavilion.

Since he was diagnosed with type 1 diabetes at age 11, 44-year-old Ben Wall has worked hard to keep the disease from preventing him from living the life he wanted to live.

Type 1 diabetes is a chronic condition caused when the pancreas produces little or no insulin, a hormone used to regulate blood sugar. The disease can often be managed by taking insulin, monitoring blood sugar, maintaining a careful diet, and leading a healthy lifestyle.

Ben has always taken his health seriously. He and his wife, Kate, have been strict vegans for 15 years and love to walk and bike. Yet, despite the couple’s healthy habits, Ben began to experience more serious diabetic complications about ten years ago. Foot wounds that would not heal, a problem Ben first experienced in his teens, grew worse, making it more difficult to be on his feet. His foot joints degenerated, requiring amputation.

Kate watched Ben’s health with increasing concern. “Each time Ben faced a new complication, we were waiting for the other shoe to drop,” she says. “As his condition got more complicated, it felt like it was just raining shoes.”

Eventually, Ben’s diabetes caused kidney failure, a serious condition that requires dialysis or a kidney transplant. According to the National Institutes of Health (NIH), about one out of four adults with diabetes will develop kidney disease. 

Ben underwent dialysis, a treatment that saved his life but left him feeling drained. Several of his family members and friends volunteered to donate a kidney. Only 10 to 15 percent of patients seeking a kidney
transplant have a living donor. Transplants from a living donor last longest and work best.

It turned out that the best donor match was right under Ben’s own roof: Kate. She was more than happy to donate her kidney to her husband. “I love Ben and wanted to do everything I could to help him get healthier,” she says. 

The MedStar Georgetown Transplant Institute is the fifth largest program in the country for overall volume of kidney and pancreatic transplants. Peter Abrams, MD, director of Pancreas and Islet Cell Transplantation, performed the kidney transplant surgery once Ben was cleared for transplant.

The surgery was extremely successful, with Ben’s kidney function returning to normal within just two days. “I felt better for the first time in years,” he says. “After a bit, I was back at work, getting more active, and taking walks with Kate again.”

However, another surgery was required to keep him healthy. “Diabetes begins to injure the new kidney as soon as it’s transplanted,” explains Dr. Abrams. “A pancreas transplant, which restores normal glucose regulation, can actually cure diabetes. A healthy pancreas would protect Ben’s new kidney and prevent the development of further diabetic complications.”

When Ben had fully recovered from his kidney transplant, Dr. Abrams performed the pancreas transplant with an organ from a deceased donor. The MedStar Georgetown Transplant Institute performs more pancreas transplants than any other program in the region and achieves patient survival rates that exceed the national average. After recovery, Ben is feeling like his old self again. “I just keep feeling better and better. With my diabetes cured, I don’t need to test my blood sugar or use insulin. I feel free,” he says. 

Kate is thrilled to see Ben doing so well. “Ben was very sick for a long time and now I feel like he’s whole again. His experience shows that there’s hope in the most dire circumstances. We’re so grateful to the team at MedStar Georgetown. They put us back on the path to a better, healthier life.”