Kurt Hinrichs insists his wife’s snoring helped save his life.
Without that sound, the Gladstone father of three, now age 55, would not have awakened on that night in July 2014. He wouldn’t have reached for his glasses, stepped to the floor and collapsed when his right leg no longer bore his weight.
“I crashed,” said Hinrichs, who works in Olathe as the chief financial officer of an airline de-icing company, Global Ground Support. “I couldn’t feel anything on my right side. I’m thinking, ‘This may be a nightmare and I just need to wake up.’ ”
He’d always been generally healthy and active, shooting below-par golf and exercising. But when his wife, Alice, saw how her husband wasn’t responding to her voice — plus his face seemed unmovable, in a fixed position staring up to the right — she immediately called 911.
In a little more than an hour, Hinrichs was at St. Luke’s Hospital near the Country Club Plaza getting treatment for a stroke with a mechanical procedure that physicians say is one of the most effective stroke treatments since the advent in the 1990s of clot-busting drugs. The hospital is part of a 1,000-patient, nationwide study of the procedure — known as clot retrieval or stent retrieval — looking at its effectiveness both versus the drugs and in combination with the drugs.
Clot retrieval is used to treat what are known as ischemic strokes, meaning those caused by a blood clot lodged in a major vessel of the brain, like a boulder in a river, and robbing the brain of oxygen.
That procedure, which takes about an hour, uses a catheter snaked through a major artery, usually starting at the thigh and then up into the brain to the clot. Once there, the catheter deploys what is in essence a tiny net that snags and entangles the clot. The clot is then removed when the net and clot are pulled from the brain and body.
“We probably have better data demonstrating their efficacy than just about anything else we do in stroke,” said neurologist William Powers, the director and chair of the department of neurology at the University of North Carolina at Chapel Hill.
Powers last year was the lead author of a paper for the American Heart Association calling on doctors to make clot retrieval a priority procedure beyond just the use of clot-busting drugs for certain patients struck by ischemic strokes.
“My gut feeling is that mechanically opening the artery is a bigger deal” even than the advent of clot-busting drugs, said St. Luke’s neurologist Coleman Martin.
Martin performed Hinrichs’ procedure. He said that he and his colleagues at St. Luke’s now use clot retrieval two to three times a week on average — 120 to 140 times each year. Doctors at the University of Kansas Hospital also use it.
KU and St. Luke’s are Kansas City’s only two hospitals certified by the American Heart Association, the American Stroke Association and the Joint Commission as comprehensive stroke centers. As such, they have the staff and expertise for the procedures.
“It is not the kind of thing that every small suburban or rural hospital can do, or might ever do,” Powers said.
The study involving St. Luke’s is being sponsored by Medtronic, which makes one device known as the Solitaire.
“If we look at the statistics,” Martin said, “treating patients by removing the clot mechanically has a greater chance of reducing disability than treating them with (clot-busting drugs).”
Clot-dissolving drugs — also referred to as tPAs, for tissue plasminogen activators — remain the first-line treatment for ischemic strokes in virtually every hospital.
About 795,000 strokes occur each year in the United States, and about 130,000 people die, according to the Centers for Disease Control and Prevention. Some 87 percent of strokes are ischemic, caused by clots. The remaining 13 percent are hemorrhagic, known as brain bleeds. Strokes rank as the leading single cause of long-term disability in the U.S. and the fourth-leading cause of death.
While studies show that the tPA clot-dissolving drugs work best for smaller clots in the first 2 to 3 1/2 hours after the first symptoms of stroke, research since 2013 shows that snagging and dragging the clots out works better with much larger clots.
Early versions of clot retrieval devices go back as far as 2004, when the Food and Drug Administration first approved devices that operated less like nets and more like corkscrews to grab a clot and pull it out.
“Those devices,” Powers said, “failed when put to vigorous testing.”
The new clot retrievers are working. Powers said one vital key is being able to clear a clot no later than six hours after the first signs of stroke. Doctors would prefer to do it within the first hour to 90 minutes.
“The sooner you do it, the better,” Powers said. “Two hours is way better than five, and five is better than six.”
Certainly, with strokes, time is always of the essence whether using clot-dissolving drugs or clot retrieval devices. The longer a vessel stays clogged, the greater the chances of damage as a result of brain tissue being robbed of oxygen-rich blood.
“Studies show that for every 15 minutes delay in getting a clot out,” Martin said, “the chance of recovery falls by about 5 percent.” He said that it continues to fall by 1 percent for every three minutes.
By all standards, the doctor said, Hinrichs’ full recovery is considered a remarkable, best-case result.
As Hinrichs woke, his wife recognized the problem and almost immediately called 911. Gladstone paramedics arrived within three minutes and sped Hinrichs past other suburban hospitals to St. Luke’s, knowing it was a comprehensive stroke center.
By 11:40 p.m., a little more than an hour after the paramedics rushed Hinrichs from his home, he was in the hospital, his brain being monitored and with clot-dissolving drugs fed into this veins.
Hinrichs, tired after a business trip, had gone to bed that night shortly after 9 p.m. Assuming the stroke had happened soon after, a worst-case scenario meant that he was getting the clot-dissolving drugs about 2 1/2 hours after the stroke.
But monitors also showed the drugs weren’t working. The clot, lodged in a major vessel at the base of his brain, was too big and not dissolving quickly. The right side of his brain was deprived of oxygen.
Martin weaved the stent from an artery in Hinrichs’ thigh up through his body and to the brain. Soon he snagged the clot and began drawing it out.
“They can now see the blood is going back to the right side of my brain,” Hinrichs said.
Soon after, he could raise his arms and legs and, within four hours, he could talk.
Hinrichs’ recovery was full. He remained in the hospital for four days, was back at work on the fifth and required no further physical therapy. He now takes aspirin to thin this blood and medication to lower his cholesterol.
With clot-busting drugs, Martin said, one out of about seven or eight patients is able to care for themselves after a stroke. The rest will suffer some range of disability, often depending on the patient’s age and health before the stroke, as well as how long it took to get treatment.
With clot retrieval, studies show that every fourth or fifth patient tends to return to a life largely like the one they knew before, Martin said.
“If you get the artery open within 90 minutes of the stroke starting,” Martin said, then every second patient does well.
There is a caveat.
“Does it help everybody? No,” Powers said.
Hinrichs was otherwise healthy and in his early 50s. Most stroke patients are elderly with far more complicating medical problems.
“You will find that the outcomes aren’t going to be as good in the very elderly population,” Martin said.
But it is still an option, he said. He recently performed the procedure on a 93-year-old woman who is back at home.