Patient who had stroke credits health care team and EVT procedure for saving his life
Dick Prat was home alone sitting on his chesterfield when his right arm dropped off the arm rest.
“I was a little cloudy and I thought maybe I’d fallen asleep,” recalled Prat. “I stood up and my arm dropped. I was drooling a little. I thought, ‘I know what this is…’”
He was having a stroke.
He picked up the phone to call for help. He didn’t think to call 9-1-1 and didn’t know any numbers by heart, so he dialled the last number he had called - his wife’s.
When she heard him talk, she asked, “Have you been in an accident?”
“I didn’t realize I couldn’t talk until then,” said Prat.
His wife called 9-1-1 immediately.
When Emergency Health Services (EHS) arrived, “The paramedics did their tests and asked me to walk out onto the gurney outside,” said Prat. “They took me to the hospital where there was a team of people waiting for me.”
Prat was transported to the Halifax Infirmary site of the QEII Health Sciences Centre.
The team who cared for him, made up of a surgeon, nurse, technologist and anesthesiologist, followed the stroke protocol, which is considered the gold standard in treatment following a stroke.
As part of this protocol, once EHS paramedics have assessed the patient and determined they are having a stroke, they call ahead to the emergency department.
After arriving at the hospital the patient undergoes a CT scan, which establishes whether they need a tissue plasminogen activator (TPA) – a clot busting medication that is given through an IV.
In cases such as Prat’s, where a large blood vessel in the brain is blocked, patients then undergo a procedure called Endovascular Thrombectomy, or EVT, to remove the blood clot.
With EVT, an interventional neuroradiologist inserts a catheter through the main artery in the groin, and threads it up into the brain to remove the clot, either using a retrievable stent or a suction device, or sometimes both.
To optimize the person’s recovery and post-stroke function, the protocol aims to remove the clot as quickly as possible following the stroke.
Dr. David Volders, the interventional neuroradiologist who conducted Prat’s EVT, along with a team of providers, said two-million brain cells are lost each minute that the brain is blocked.
He borrows a quote from colleague Dr. Stephen Phillips: “Time is brain.”
“Even if a patient comes in directly after having a stroke, the clock is ticking,” said Volders.
In Prat’s case, quick intervention ultimately translated into a full recovery.
“When I came out of the operating room they were talking to me and I could talk lucidly,” said Prat.
Unfortunately a short time later, Prat again lost his ability to speak and had trouble swallowing.
This brief relapse was due to the larger clot breaking up into fragments due to the procedure. These fragments of blood clot can block other smaller arteries in the brain, but then may be cleared by the clot busting medication given earlier.
Fortunately, Prat recovered exceptionally well. He was discharged from hospital a week after the stroke and returned to driving within a month.
After his first post-stroke speech test, Prat was told, “You can go back to your former career in broadcasting.”
A national research study called OPTIMISE is comparing results of EVT treatment across Canada.
The procedure was first used in Nova Scotia on Christmas Day 2011. Since then, use of the treatment has steadily increased. In 2019, 61 patients underwent EVT at the QEII Health Sciences Centre, up from 14 in 2013.
As part of the study, Susannah Piercey, research coordinator with the Neurology acute care team at the QEII’s Halifax Infirmary, checks in with patients every 90 days to see how they’re doing.
She said, “On average, patients who have undergone EVT aren’t staying in hospital as long and many are going home and living normal lives again. This work is changing lives.”
Dr. Volders said he is often struck by how quickly individuals improve after EVT. He described checking on patients the day after treatment. “I sometimes see patients sitting up in bed, talking and I think, ‘Is this the same patient?’”
Prat would agree with the dramatic and life-changing impact of EVT.
“They saved my life – no question,” he said of the team who treated him, noting he was told that without this treatment, the massive strove would have been debilitating.
“Staff were tremendous – caring, compassionate – they took the time to explain things so that a novice like me would understand what was happening and where things were going.”
Would you recognize the signs of stroke? https://www.heartandstroke.ca/stroke/signs-of-stroke