By Eve Clayton, Spectrum Health Beat
Photos by Taylor Ballek
Tramell Louis Jr. has diabetes, and his friends all know it.
So when he collapsed at lunch while waiting to place his order, his buddy thought Tramell was having a diabetic attack.
He helped him out to his car and called LaGenda, Tramell’s wife, who drove to meet them outside the restaurant.
It didn’t take her long to figure out that this was no low-blood-sugar attack, so she followed her instincts and called 911.
“I’m asking him questions and he’s looking at me, but he won’t respond. So at that point I knew something was grotesquely wrong,” she said. “I just knew it wasn’t related to the diabetes.”
As she watched “his mouth go crooked,” she wondered whether he was having a stroke.
Clot retrieval
An ambulance took Tramell to the emergency department at Spectrum Health Butterworth Hospital, where doctors confirmed LaGenda’s suspicions: At age 37, her husband had suffered an acute ischemic stroke.
The doctors quickly got him hooked up to an intravenous drip and administered a clot-busting medicine known as IV tPA. As the only drug approved by the Food and Drug Administration for treating acute ischemic stroke, this is the standard of care in a case like Tramell’s.
At the same time, emergency room staff called one of the hospital’s stroke specialists, who ordered a CT angiogram to pinpoint the source of the stroke. Tramell was rushed to the interventional radiology suite for imaging.
With the images on screen, the Spectrum Health Medical Group neurointerventionalist could see that Tramell was a perfect candidate for an advanced intervention called a mechanical thrombectomy, or clot retrieval.
Tramell’s brain scans showed two blood clots—one in the carotid artery in his neck and the other lodged in the left-middle cerebral artery, a major artery supplying the brain.
This second clot had shut down the blood flow to the left side of his brain, like a dam blocking a river.
“When the doctor showed me the CT scan of his brain, you could clearly see that (one) side of his brain had no blood flow to it at all,” LaGenda recalled.
Time is brain
With stroke, speed is everything. The longer the brain is deprived of blood, the more damage the brain suffers.
Studies have shown that for every minute blood supply is blocked, approximately 2 million neurons die.
So if a patient fits the criteria for intervention, “the sooner you start the procedure, the sooner you take out the blood clot, the sooner you restore the blood flow, the better the outcomes at three months.” That’s the standard measurement in the United States today.
Thankfully, Tramell beat the clock. From the moment he arrived at the hospital to the time he underwent surgery, less than an hour had passed.
Because there were two clots, the doctor used a two-step process to retrieve them. First he inserted a catheter into a blood vessel in the patient’s groin and fed it up to the carotid artery. Using a tool called the Solitaire device, he trapped the first clot in a tiny mesh stent and pulled it out.
Then he repeated the technique, fishing out the clot in the central brain. Immediately the blood began to flow again, in what doctors call complete recanalization—the channel was open again.
The results for Tramell proved to be dramatic.
His symptoms—loss of language function and right-side weakness—improved literally overnight, said Vivek Rai, MD, a neurologist with Spectrum Health Medical Group who specializes in stroke and vascular neurology. He took over Tramell’s care after his release from intensive care.
“After the procedure, the next morning when he woke up, he was night and day,” Dr. Rai said. “And he continued to do so well.”
Now that Tramell is in the clear, Dr. Rai will see him annually in the neurovascular program’s stroke clinic, keeping tabs on his carotid artery disease, which was the cause of the stroke, and monitoring his general health. To prevent a future stroke, Tramell will need to take aspirin and cholesterol medication, and carefully control his diabetes and blood pressure.
Driven to change
At five months post stroke, Tramell is feeling better than ever.
“I feel great. I really do,” he said. “I feel healthier than I have in a long time.”
He looks and sounds healthy, too, with no lingering effects. At least, none that a bystander would notice.
“The only problem I have is my speech,” he said. “When I speak, if it’s a word I haven’t used after I had my stroke, it takes—it’s like a pause and then I have to remember the word and then it jogs it, and then I start using it fluently.”
The stroke served as a major wake-up call for the father of two. Realizing his life could be snatched from him—separating him from his wife and children—brought out strong emotions.
“I felt anger, extreme anger—with myself. I just knew I had to change. I had the worst—the worst—eating habits in the world,” he said, noting that before he started taking insulin, he weighed over 300 pounds.
Today Tramell is eating better, faithfully taking his medications, drinking more water, kicking his soda habit and “running on a treadmill like crazy”—even when his job as a shipping and receiving clerk keeps him at work late.
“My wife—she’s the one that motivates me to do all the things I do,” he said.
Reprinted with permission from Spectrum Health Beat.
