If Walterson had suffered his stroke just a few years earlier, or on the same day in another part of the world, his prognosis would have looked entirely different. Instead, he received a recently developed treatment, one established in part by the neurology team at Foothills: what’s called an endovascular thrombectomy, or EVT. In the hospital’s angiography suite, a neuroradiologist, guided by X-ray imaging, pierced Walterson’s femoral artery at the top of his inner thigh and threaded a microcatheter through his body, northbound to the brain. The clot was extracted from his middle cerebral artery and pulled out through the incision in his groin. Just like that, blood flow was restored, and soon his symptoms all but disappeared.
A little more than 24 hours later, Walterson’s memory kicked back in, when he was lying in a narrow bed on the stroke ward. He ate breakfast. He answered questions from the doctors on the stroke team as they made their rounds. By Sunday afternoon he could manage to walk around the ward, cracking jokes while a stroke neurology fellow hovered nearby. “Do you want to hold my hand?” she asked. “People will talk,” he replied, and shuffled along on his own. It wasn’t until Monday afternoon, as he laced up his black sneakers and prepared to head home, that he asked another stroke fellow, Dr. Kimia Ghavami, how bad he was on Friday during those hours he could no longer remember.
“When I met you,” she said, “you were completely paralyzed on your left side.” Without the EVT, Walterson would most likely have been facing a best case of weeks in the hospital and months more of rehab. The worst case, if he survived at all: a feeding tube, permanent immobilization and a much-shortened life in a bed in a long-term care facility. It could have been catastrophic, but here he was, hearing about his now-vanished symptoms secondhand.
Stroke kills about six and a half million people around the world annually. It’s the second most common cause of death worldwide, and it consistently ranks among the top five causes of death in Canada and the United States. Beyond the raw death toll, stroke is also a leading global cause of disability — too often, it leaves behind the kinds of severe deficits that force loved ones to become full-time caregivers. Even smaller, less severe strokes are associated with the onset of dementia and many other complications.
Given that toll, it’s no exaggeration to call the EVT one of the most important medical innovations of the past decade, with the potential to save millions of lives and livelihoods. Neurointerventionalists in the United States now complete roughly 60,000 EVTs per year. (Last year, one of them appears to have been done on John Fetterman while he was a Democratic candidate for senator, which means the procedure may have helped determine control of the U.S. Senate.) But the overall number of Americans who could have benefited from an EVT is at least twice that.
