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Direct Carotid Puncture Saves Stroke Patients

NEW HAVEN, Conn. (WGEM)— When a loved one is having a stroke, time is everything.

Drugs to break up the clot that is stopping blood flow must be administered within four and a half hours to work.

Clot removal, or thrombectomy, has a 24-hour window.

Now, neurosurgeons are studying an old approach to clot removal in patients who would otherwise be out of options.

Joan Guardiano plays a mean hand of gin rummy, even as she recovers from a massive stroke.

Last summer, Joan’s family stopped by to visit and found her...unresponsive.

“She was on the ground and she couldn't talk, she was slurring her words,” recalled Joan’s son, Vince Guardiano.

“I was in the ambulance and that was it. I don’t remember one thing after that,” Joan shared.

“I understand there's some kind of medication that they can give before, within a certain timeframe. I think she missed that timeframe,” Vince explained.

Yale neurovascular surgeon Charles Matouk moved to the next option—removing a clot by passing a catheter through the groin into the larger arteries. But surgeons were having trouble.

“The problem is, is that as we get older, our blood vessels become more twisted and they become more difficult to navigate,” described Dr. Matouk, chief of neurovascular surgery at Yale School of Medicine.

Instead, surgeons used a different approach with Joan. It’s called direct carotid puncture—accessing the clot through the neck, near the collarbone.

“And that creates a very convenient space where you are going to miss all the nerves and veins that coarse through the neck and gives us easy access to the carotid artery,” elaborated Dr. Matouk.

Doctors used direct carotid puncture in the sixties but abandoned the procedure when new medical tools made entry through the leg a safe option.

Dr. Matouk says the direct carotid puncture could save about ten percent of stroke patients who had no other options.

Patients, like Joan Guardiano, who survived her stroke, and feels good about the hand she’s been dealt.

After studying the direct carotid procedure, Dr. Matouk says Yale neurosurgeons have incorporated the procedure back into their operating room.

He says surgeons try traditional clot removal for about 15 minutes, and if a patient’s anatomy makes access too difficult, they switch to the direct carotid punch.

He says other hospitals with large neurosurgery departments are also incorporating the technique.

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Don Dwyer

Don Dwyer is a Morning Anchor/Reporter at WGEM.

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