Doing the 'Unthinkable': Doctor Saves a Life with Daring Brain Treatment

Doctor administers clot-busting drug to save a patient's life.

Clot-busting drug administered to save patient's life
Dual stroke survivor Debi Shackleford has total confidence in neuro-intensivist Victor Zach, MD, whose daring brain treatment procedure saved her life.

Debi Shackleford is glad her heart unexpectedly went into overdrive. "If it hadn’t started beating really hard," she said, "I probably wouldn't have gone to the doctor."

Although her blood pressure had climbed the previous year, she couldn't imagine that anything was seriously wrong with her. She had always been healthy and active.

In February, Debi thought a splitting headache, nausea and vomiting added up to the flu. She finally made a doctor's appointment when her heart started pounding. The nurse practitioner urged her to go to the Emergency Department.

The 24/7 stroke team at John C. Lincoln North Mountain Hospital, an accredited Stroke Center, discovered that Debi had suffered a rare stroke that’s often fatal.

Dual stroke Issues

Most strokes are caused by blood clots that block the flow of oxygen through the brain's arteries. An intravenous drug called tPA can dissolve the clot, restoring blood flow and normal function if administered quickly enough.

A small percentage of strokes is caused when a blood vessel breaks and bleeds into the brain, sometimes requiring surgery. Ordinarily, treating this kind of stroke with intravenous tPA would worsen the bleeding.

But Debi had both problems, said board-certified stroke expert, neuro-intensivist Victor Zach, MD.

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With a brain bleed called an intraventricular hemorrhage, Debi's brain filled with blood that solidified into a clot, closing off the outflow of cerebrospinal fluid (CSF).

If CSF builds up dangerously, a condition called hydrocephalus, a shunt must be surgically inserted to drain the fluid and ease pressure on the brain.

"I remember being terrified when they said they were going to drill a hole in my head," Debi said. But Dr. Zach explained everything. He was so calm and confident ... he made me believe he was going to fix my problem – and he did!"

Dr. Zach drilled through her skull and inserted a catheter to drain the CSF and reduce pressure. That was standard procedure. What happened next was not.

Basing his action on clinical research he'd done in New York, Dr. Zach said he "did the unthinkable. I gave a patient with a brain bleed a clotbuster. This was a John C. Lincoln first."

Direct Delivery to Clot

Delivering the drug intravenously would have aggravated the brain bleeding. Instead, he maneuvered the catheter through the burr hole and administered tPA directly into the clot, dissolving it without aggravating the bleeding.

Without this innovative treatment, he said, clinical trials show the death rate from Debi's condition as high as 56 percent. Half who do survive without intraventricular tPA become dependent on shunts.

"What happened next was miraculous," he said. "The head CT scan done the next day revealed complete resolution of the blood clot and return of normal CSF flow."

"I recovered really quickly," Debi said. "I was in ICU five days and a nursing unit two days. I felt pretty good, but my brain felt a bit rusty."

She went to and spent a week trying to beat its games. "It really helped," she said. "I'm a mutuel teller for the dog track, and you have to be on the very top of your game. I was. God and Dr. Zach gave me a second chance at life."

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