Lucky stroke

Last summer, Stefan Reisch was driving west on the I-8 near Waring Road at 9:30 in the morning when it hit.

"I thought, Are you having a stroke? But that couldn't be,” he says. "So I continued to drive to work in a kind of dream state." Reisch didn't realize what was happening — a common symptom and reaction, stroke experts say.

So, the 42-year-old father of two drove on toward the Pacific Beach salon he runs with his wife. "Cars were honking at me — I was completely paralyzed on the left side and I couldn't see. I must have been weaving around but I continued to drive to West Mission Bay until I ran off the road into the iceplant," he says.

By then, other drivers had called police about a drunk driver, and when Reisch crashed, police and firefighters arrived right away.

"The firefighter started talking to me. He asked me if I was drunk, if I was on drugs, and I said no," Reisch remembers. "Then he goes, ‘Smile for me,’ and I did, and he said, ‘I think you're having a stroke, buddy. Let's get you to the hospital.’”

There are few things you can tell a patient more frightening than that, says Dr. Alexander Khalessi, who met Reisch in the emergency room last August. Khalessi says strokes are the third leading cause of disability and death, and in the emergency room, the stroke victim is a long way from knowing how bad it will get and what they will have left if they recover.

"There are studies that show no one wants to be disabled that way; they'd rather pass away," Khalessi says. "I meet people on the worst day of their lives."

But on that day — August 27, 2014 — Khalessi was working with a new tool that lets doctors go into the patient's brain and actually snatch the clot and pull it out — a revolution in treatment.

There are two kinds of strokes: blockages to any of four arteries account for 85 percent, while the rest are hemorrhagic, bleeding from injuries or aneurysms. Blockages interrupt the flow of blood — oxygen and nutrients — to parts of the brain that are quickly damaged and start to die — what Khalessi calls “an insult” to the brain. Blockages come in different sizes and to different locations, and the damage can be minor or extensive, depending on where they hit and for how long. So, the speed at which a victim receives treatment matters.

Within minutes of his arrival at UCSD hospital in Hillcrest, doctors diagnosed Reisch with a blockage to his right carotid artery and administered tPA, a blood thinner that can wash the clot away. And the staff called Jennelle Reisch, who raced to the hospital and found her husband of 20 years completely paralyzed on his left side — including being unable to see or hear.

Jennelle and Stefan Reisch listened to Khalessi. The tPA wasn't working. The next step would be to either freeze Stefan’s brain or to try Khalessi's stent-retriever — sending a catheter through veins in his groin and up to his brain to snatch the blockage out.

"I heard ‘freezing’ or ‘groin’; I didn't like the sound of either, so I told Jennelle to pick," Stefan says. "She couldn't, so I thought, Well, I was freezing already. I don't want to get any colder.”

Within 45 minutes, Khalessi was threading a catheter into Stefan’s brain — which doesn't hurt, both say. Stefan was awake. At one point, he got restless and said he wanted to sit up.

"He said, ‘No, can you wait five minutes? I'm in your brain,'” Stefan says.

Arteries, unlike brain matter, do having feeling, and Stefan felt the clot come out.

"I got the clot and Stefan said, 'I just got a headache,’” Khalessi remembers.

For Stefan, the impact was almost immediate, which isn't always the case. "Within five minutes I could move my leg and my hand," he says. "They were yelling, ‘We’ve got movement!’ and then I was waving and giving people high-fives."

For the people in the room for the procedure, it was a great moment. "It is the most dramatic thing you can see in medicine," Khalessi said.

Early studies are finding that the stent-retrievers work well at restoring blood flow to the brain, but that it doesn't guarantee the patient will fully recover.

“[The] discrepancy between good technical and still less satisfactory clinical results might have several causes, such as severity of stroke, patient selection, time to treatment, duration of procedure or concomitant anticoagulation treatment," a recent study says.

Stefan's was a best-case scenario: relatively young, healthy, his brain freed of the clot within an hour or two of the stroke. Khalessi and the Reisches say they are telling their story because they want people to know two things: that people who are having strokes don't expect them and need help, and that treatment for strokes has changed a lot for the better — if you get to the right place fast enough.

"Often patients don't realize and recognize that they're having a stroke — you really rely on someone else to recognize you're having one," Khalessi says. "Often, the person will try to wave off help. That makes it your best ever opportunity to save someone's life."