“These doctors saved my life”
HHS a leader in ‘gold standard’ brain clot removal
Last November, Brantford resident Lynn Matthews experienced a large, life-threatening blood clot in her brain. The clot was sizable enough to clog a major vessel, putting her in grave danger of life-altering brain damage or even death due to stroke.
But thanks to endovascular therapy (EVT) at Hamilton Health Sciences (HHS) Hamilton General Hospital (HGH), Matthews fully recovered and is back to enjoying her grandchildren, great-grandchildren and favorite pastimes like playing cards, dancing and swimming.
“EVT is probably the most significant advancement in stroke care I’ve seen in my nearly 40-year career.” — Rhonda McNicoll-Whiteman, HGH clinical nurse specialist, EVT lead
What is EVT?
EVT is an emergency stroke procedure that removes large blood clots lodged in major vessels in the brain. It’s reserved for patients with this extremely serious type of brain clot, and is considered the gold standard in treatment.
Thanks to lifesaving EVT treatment, Lynn Matthews is back to enjoying favorite activities like playing cards.
As the tertiary stroke centre for the central-south region of Ontario, HGH provides specialized stroke treatment including EVT for patients with the most complex, severe, and urgent conditions. In our region, EVT is performed only at HGH.
“EVT is probably the most significant advancement in stroke care I’ve seen in my nearly 40-year career,” says Rhonda McNicoll-Whiteman, an HGH clinical nurse specialist and the hospital’s EVT lead.
How EVT works
During EVT, a neuro-interventional physician threads a thin wire through an artery in the patient’s groin, up through the body to the brain. She uses X-ray imaging to guide the wire to the clot blocking the large blood vessel in the brain. A stent or vacuum device is then used to capture and remove the clot, restoring blood flow.
Dr. Luciana Catanese, HGH stroke neurologist, regional stroke medical lead for hyperacute stroke care
HGH has been performing EVT since 2016. Prior to EVT, the only treatment option for patients like Matthews was a clot-busting medication. But clot busters aren’t always powerful enough to completely break up large obstructions. Studies show that only 10 to 25 percent of patients fully recover with clot-busting medications alone, while EVT increases the chance of a full recovery to an impressive 46 per cent.
“It takes just minutes for the brain to start dying, and we can minimize damage through quick intervention.” — Dr. Luciana Catanese
The hospital’s EVT team includes neuro-interventional physicians, stroke neurologists, fellows, residents, anesthesiologists, interventional radiology nurses and technologists. Many HHS specialists are also leading-edge stroke researchers at the renowned Population Research Health Institute, a joint institute of HHS and McMaster University.
“They’re involved in major international trials, and our patients directly benefit because they have opportunities to try promising new investigational therapies in stroke,” says Dr. Luciana Catanese, an HGH stroke neurologist and regional stroke medical lead for hyperacute stroke care.
Store manager’s fast action
Matthews, age 76, was grocery shopping when she suddenly dropped to the floor, unable to move. “Thankfully, the store manager who came to my assistance was trained in first aid and recognized that I was having a stroke,” says Matthews, adding that the store called 911 immediately.
“There were some brain cells that died, but the damage was minor. I would be able to return to my normal life and enjoy all of what life has to offer.” — Lynn Matthews, patient
Paramedics rushed Matthews by ambulance to Branford General Hospital, one of the region’s five primary stroke centres, where it was determined she needed the EVT procedure. She was given clot-busting medication in Brantford, and then transferred by ambulance to HGH for EVT.
“While in the ambulance, I thought of my grandmother who had a stroke in her 60s,” recalls Matthews. “I thought about how the left side of her body was paralyzed, and how she was put in bed and left there until she died. I also thought of my own mother who had a similar stroke at 80 years of age, and how she was alone and unable to get help, and died shortly after.”
Within two-and-a-half hours of collapsing in the grocery store, Matthews underwent EVT. “The doctors were ready when I arrived,” says Matthews, whose symptoms included left-side paralysis, a droopy face and slurred speech.
“These doctors saved my life,” she says. “There were some brain cells that died, but the damage was minor. I would be able to return to my normal life and enjoy all of what life has to offer.”
Lynn Matthews shares her story:
React FAST and call 911
EVT is reserved for people with a large clot blocking a major vessel in the brain, who were independent before their stroke.
“It takes just minutes for the brain to start dying, and we can minimize damage through quick intervention,” says Catanese. Prompt medical treatment can quickly restore blood flow, minimizing brain damage and significantly improving the chances of recovery. “A fast response is critical because every minute counts in preserving brain function and improving recovery.”
If you or someone you know shows signs of stroke, it’s vital to call 911. It’s also important to react FAST to the signs. “Don’t attempt to drive or have someone drive you, as this can delay care and reduce your chances of recovering without disability and surviving from the stroke,” says Catanese.
A Canadian first
Dr. Luciana Catanese examines an image of a blood clot in a brain.
The goal is to deliver EVT within six hours of stroke symptoms but this isn’t always possible. For example, a person experiencing stroke may have been home alone, and not discovered right away. When this is the case, CT perfusion with scanning using artificial intelligence (AI) software can quickly provide highly detailed information on areas of the brain that are salvageable, from six to 24 hours after stroke, allowing physicians to identify a wider range of patients who can benefit from EVT.
Our region was the first in Canada to implement CT perfusion scanning using AI software at HGH and the region’s five primary stroke centre hospitals, as a hub-and-spoke model.
This scan generates color-coded brain maps showing where blood flow to the brain is cut off, as well as areas of the brain that can be saved. The AI software rapidly analyzes the images and quickly provides a measure of the salvageable brain to help determine if EVT is a treatment option. Prior to this technology, patients were only eligible for EVT within six hours of their stroke.
Implementing and coordinating this technology as a hub-and-spoke model linking HGH and primary stroke centres was a huge undertaking that included working through a myriad of privacy and security considerations, says McNicoll-Whiteman. It’s a unique model that other stroke centres in Ontario and Canada have expressed interest in. “We’re leaders in this model, and we were pleased to share our experiences with other centres,” she says.
The regional stroke centre plans to showcase this model for using CT perfusion and AI in May, to Accreditation Canada, as part of its Stroke Distinction program. “We’re looking forward to sharing how this technology, and our model for using it, demonstrates best practice as well as improved outcomes for patients,” says McNicoll-Whiteman.
EVT by the numbers
- Our region includes one tertiary stroke centre (HGH) and five primary stroke centres: Brantford General Hospital, Joseph Brant Hospital in Burlington, Grand River Hospital in Kitchener, Guelph General Hospital and Niagara Falls Hospital. People in the region needing EVT are transferred by ambulance to HGH.
- In 2025, just under 250 patients are expected to receive EVT at HGH. About 30 per cent will arrive directly to HGH’s emergency department from the Hamilton area, and the remaining 70 per cent will come from the region.
- Sixty minutes is the benchmark for getting patients EVT treatment, from the moment they arrive at HGH’s emergency department. The hospital’s EVT team is well within that timeframe, averaging about 50 minutes from arrival to treatment.
- During a stroke, blood flow to the brain is blocked or reduced, depriving brain cells of oxygen. Without oxygen, approximately two million brain cells die every minute, increasing the risk of permanent brain damage, disability, or death.
