By Michael Haederle

Remarkable Recovery

State-of-the-Art Intervention Saved Ann Kenyon From a Devastating Stroke

Around 9 o'clock on the evening of Sunday, May 19, Ann and Jerry Kenyon were watching a TV show in their rural hilltop home outside Abiquiu, N.M., when they decided to get up to fix a bowl of ice cream.

Ann had just opened the door to the pantry off the kitchen when she noticed something peculiar. She could no longer move the right side of her body. Jerry looked at her: the right side of her face was drooping, and when she tried to speak, a string of garbled syllables came out.

"Oh God," he said. "You're having a stroke." He helped her down the hall to the bedroom and got her to lie down while he called 911.

Dispatchers alerted David Klein, the Kenyons' neighbor and close friend, who is also the district chief of the Abiquiu Volunteer Fire Department. Klein and his fellow firefighters reached the home within 10 minutes.

"I was emotional, to say the least," Klein says of seeing his friend suffering from obvious stroke symptoms. But his training kicked in. He called dispatchers in Española and asked them to send an air ambulance to transport Ann to a stroke center.

Emergency medical technician Ruth Ann Johnson, a retired trauma nurse, comforted Ann as she was loaded into the ambulance for the short ride to the fire station, where fellow firefighters set out beacons to guide the helicopter to a safe landing zone.

Less than an hour after the onset of her symptoms, Ann was loaded onto the chopper. There was no room onboard for Jerry, so he turned to a crewmember. "I said, 'Here's my phone number I'm going to be at home. Please call me when you land.'"

Jerry didn't know it, but his wife was en route to University of New Mexico Hospital, the state's only Level I trauma center. Advance word from the air ambulance crew had already activated the stroke team, trained to provide state-of-the-art care for stroke victims. The chopper touched down on the roof of the hospital and Ann arrived in the emergency department within three hours after the onset of her symptoms.

"We quickly realized it was a very classical stroke presentation, and we sent her for a quick CT scan and a CAT scan of her arteries," says vascular neurologist Tarun Girotra, MD. The scan showed a clot in one of the major arteries supplying blood to the left side of Ann's brain.

"That artery is particularly important," Girotra says, "because it goes to that part of the brain that allows us to understand language and express ourselves, and also to move the right side of the body."

The scan results suggested that Ann was an ideal candidate for a procedure called a thrombectomy, in which the clot is mechanically retrieved from the artery, restoring blood flow to the brain.

Recent studies have shown that patients often have a good outcome if the procedure occurs within six hours - and sometimes even longer. The stroke team alerted cerebrovascular neurosurgeon Andrew Carlson, MD, who was on call that evening.

Carlson has a highly trained team of his own to perform the procedure. When he met Ann, she was awake, but unable to move or communicate. She was given a mild sedative. Then, making a small puncture in her femoral artery, Carlson carefully threaded a thin, flexible catheter up the artery, passing through her aorta and into her brain, closely watching each movement on an X-ray screen.

Using stents and aspiration tubes, Carlson pulled the blockage out of the large artery, which immediately restored the flow of oxygen-rich blood to the left side of Ann's brain.

"She was just a very perfect case of how everything should go," he says. "We were able to get access to the clot quickly, and then quite remarkably, she started moving that right side again on the table, which is exactly the kind of outcome we hope for the best cases."

* * *

The symptoms came on "in the blink of an eye," Ann remembers. She'd always assumed a stroke might be foreshadowed by a headache, but in this case there were no warning signs: she simply couldn't move or speak.

Although the 70-year-old retired speech pathologist could understand what people were telling her, she was in a state of denial about the severity of her condition.

"I didn't believe I had a stroke, but I couldn't talk," she says. "I think something took over, because during the helicopter ride, I kept thinking, 'Well, this is a nice way to go to the hospital. It's a beautiful night to enjoy the lights of Santa Fe and Albuquerque, and when we get to the hospital, they'll take care of it.'"

At the hospital, she was frustrated, because she couldn't respond to what the doctors and nurses were saying. But she followed Carlson's instructions to lie still as he worked the catheter up into her brain, following his movements on the screen out of the corner of her eye.

"Then at the end, he said, 'I'm done. We got it, Ann. You're going to be OK,'" she says. "I tried to say thank-you, and I couldn't get it out, and it was very frustrating. I think I started crying a little bit at that point, because I wanted to say thank you."

She was moved to a room where a nurse checked on her neurological status every 15 minutes. "The first couple of times I couldn't get anything out," she says. "But by the third time I started speaking. By 4 o'clock that morning everything was back to normal. I could raise my arm and leg, and I could answer questions."

* * *

For Jerry, the wait at home was agonizing.

"I kept thinking about all the people that I know that have had strokes and are either permanently disabled or can't speak for months and have to go for training and physical therapy," he says. "I was very worried about that, and really relieved when the doctor called and said, 'We were able to get it. She seems to be responding.'"

When he joined Ann in Albuquerque the next morning, she was already up and walking around, but she would remain at UNMH for several days of tests to see if doctors could identify what had caused the clot. One of her doctors suspected she was experiencing an abnormal heart rhythm called atrial fibrillation.

"He said, 'Your heart is stopping for six to eight seconds at a time, and that's what's causing these clots to form,'" Jerry says. "When the heart starts again, that's what sends the clot out into the artery."

The diagnosis explained some of what Ann had been experiencing. Although she had been on blood pressure medication for years, she had recently noticed her stamina was waning. "I would just have all these dizzy spells and weakness and felt like I was going to faint," she says. "I truly believe now that was what was happening and it just had not been diagnosed."

Her doctors immediately switched her from daily aspirin to a stronger blood-thinning drug as a way of reducing her stroke risk. She was discharged from the hospital on Thursday, May 23. That Saturday evening, the Kenyons had dinner with fire chief David Klein and his wife.

"There was a bigger story to tell than usual, but it was Ann Kenyon, 100 percent," Klein says, still marveling at her recovery. "There was no sign of anything. And I was there when she wasn't able to speak . . ."

* * *

Ann Kenyon's case is a textbook example of how state-of-the-art stroke treatment can save lives and avoid long-term disability, Carlson says.

"She really was quite a remarkable patient," he says. "I think she realized very early, even when I saw her the next day, how much had come together to make everything work perfectly for her, from the initial recognition by her family, through EMS, through the very quick activation here at UNM, and then through the procedure with everything running smoothly."

Girotra says the UNM stroke team is hard at work educating emergency room doctors at smaller community hospitals about how to better respond to stroke. A key component is UNM's ACCESS program. It provides for a real-time consult by UNM neurologists who can use tele-technology to observe patients and view their neuroimaging results to advise whether they should be airlifted to UNMH for treatment.

But many doctors remain unaware that while thrombectomy may improve outcomes for up to 24 hours in some cases, the sooner a patient receives the procedure, the better.

"That's the core of our message," Girotra says. "We should approach stroke with the utmost urgency. We shouldn't delay. If there is a concern, call the appropriate team: we are here to help."

* * *

A few weeks after her discharge, Ann returned to UNMH to have a pacemaker implanted. It's considered the best long-term treatment for atrial fibrillation. "I am feeling better than I have in two years," she says.

Ann and Jerry know how fortunate they are. And they're extremely thankful for the efforts and professionalism of the EMTs, air ambulance crew and UNMH medical team.

"I just keep thinking about the term, 'Everything that could go wrong did go wrong,'" Jerry says. "In this case, everything that could be right was right. It was just amazing."

Ann's doctors have told her she can expect to resume her normal activities, and should have very little risk of stroke in the future. "I can't say enough nice things about the hospital staff and the doctors," she says.

"They all just were very clear about what had happened, what I needed to do and what they were going to do each step of the way - just very supportive!"

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