Minimally invasive brain clot surgery using new device is a first in NC
On the afternoon of June 4, Milton Rawls knocked on his mom’s apartment door and then let himself in like all her adult kids, expecting to see her watching TV after a hard day at work as a retirement center cook. Instead, he found her collapsed on the floor and barely conscious.
An ambulance rushed her to Novant Health Matthews Medical Center, where Frances Rawls she was diagnosed with a bleeding stroke and transferred to Novant Health Presbyterian Medical Center, which was recognized as the first comprehensive stroke center in Charlotte in 2017.
Doctors then determined the 65-year-old grandmother of 11 had suffered a blood vessel burst deep inside her brain – known as a hemorrhagic stroke – and it was causing substantial pressure on her brain. She needed surgery.
That can be a risky procedure for patients, because it means surgeons have to remove part of the skull and cut through undamaged but delicate brain matter to get to the injury. That can lead to permanent brain damage and a potentially poor prognosis for the patient.
So vascular neurosurgeon Dr. Ziad Hage proposed a minimally invasive alternative that would reduce the chances for damage to the brain while removing the clot and improving Rawls’ chances for the best recovery possible.
On June 6, and for the first time in North Carolina, he performed brain clot removal with a minimally invasive technique using the new Artemis Neuro Evacuation device. The device was cleared by the U.S. Food and Drug Administration in 2017.
“It’s just nothing short of a miracle for me,” said daughter Shalonda Maldonado, a special education teacher. “I still have my mother.”
‘This was excellent’
To perform the operation, Hage made a 2 cm incision in Rawls’ forehead and followed with a 1.5 cm opening in the skull to allow entry of a device the thickness of a pencil.
Next, Hage used a tube-shaped device called an endoscope to enter the brain. Tipped with a tiny camera, endoscopes allow surgeons to see inside the body. The device also includes a hollow tube that gives the surgeon a path into the brain where tools can be inserted.
In this case, Hage used a slender suction wand called the Artemis, which was inserted through the open endoscope tube. To pinpoint where he needed to place the Artemis, he used neuro-navigation equipment that relied on a brain scan to track the precise location of the clot and guide the scope and Artemis in. Using suction, it removed nearly the entire blood clot.
Hage said that this type of surgery on such strokes can remove up to 80 to 90 percent of the clot. In Rawls’ case, he said he was able to remove 96 percent, a great outcome because it got more of the clot while significantly reducing the chances of additional brain damage that patients risk when surgeons have to cut through the brain during traditional surgery.
“This was excellent,” he said. “Even 1 percent more removal is very important — every percentage point matters.” He also used the device to suction away blood from the ruptured vessel. That’s important, Hage said, because it relieves pressure on the brain. Blood itself, he also said, can damage normal brain tissue around it because it is toxic to normal brain cells and needs to be removed.
Hage said he elected to perform the new procedure, with the family’s permission, because he knew Rawls was a good candidate for it, which has come into use with the availability of the Artemis device.
“She now has a better shot at returning to normal activity as possible,” Hage said. Still, Rawls faces significant challenges. Much of her left side was left paralyzed from the stroke itself. It’s not clear how long she laid on the floor of her home after suffering the stroke.
“Hopefully she’ll regain some function,” he said. “We’ve been surprised before. Only time will tell.”
And when it comes to the use of the Artemis device, he said, minimally invasive brain surgery in cases like Rawls’ will become more common as surgeons become aware of its use and potential.
Every year, more than 795,000 people in the United States have a stroke, according to the Centers for Disease Control and Prevention. And stroke kills around 140,000 in America each year.
It’s the fifth leading cause of death for Americans. The risk of having a first stroke is nearly twice as high for blacks as it is for whites.
Today, Rawls’ recovery is well underway.
Maldonado, her daughter, said her mother’s fighting spirit has been on full display in notes she writes from her bed. In one exchange, she announced she was ready to leave the hospital and ordered her children to load her up and take her home.
“I said, ‘Mom, we can’t do that yet,’” Maldonado said. Rawls grabbed her pen and scribbled a follow-up note that she would call an Uber car to come and get her. It wasn’t clear, Maldonado said, if her mother was joking. “She’s feisty.” While it’s difficult for Rawls to speak, she is able to get some words out.
Maldonado, a busy professional and mom with three kids at home, knows her family members have much to navigate as they manage Rawls’ recovery. But at the moment, she’s grateful for the care at Novant Health that got them so far.
“We were so scared that we were going to lose our mother,” she said. “We’re just relieved that Dr. Hage was so knowledgeable about all of this. When I heard her speak her first words, I just felt so lucky.”