Clot-busting UW doctor helps avert damage from strokes

A ringing phone in the middle of the night tells Beverly Aagaard that someone’s brain is starting to die. Chances are good that, within minutes, she’ll be at UW Hospital prepared to snake a small catheter into the deep blood vessels of that brain.

It is not a job for the faint of heart—or the timid of mind. Aagaard is an interventional neuroradiologist, one of a small cadre of physicians who use sophisticated imaging techniques to treat various medical problems in the brain. One of the most common—and potentially devastating—is stroke, which kills thousands of Americans every year and disables many thousands of others. As recently as a decade ago, medicine had little to offer stroke patients to prevent neurological damage, and many people still believe that strokes are not an emergency because nothing can be done.

But with the advent of new medicines and technologies to treat strokes and other neurological catastrophes, the skills of people like Aagaard and her colleagues may be the only barrier between a patient and a lifetime of disability.

“We look at the blood vessels and say “Where is the blockage, and what’s it going to take to fix it?'” she says. “I thread a microcatheter up into the blood vessels of the brain itself. I try to pass the catheter through the clot if I can, gently, because you can’t see where you’re going. You just have to know what the anatomy is likely to be.”

One of the nation’s few female physicians in a small subspecialty, Aagaard joined the UW Medical School faculty in August 2000 after nearly two decades of arduous training. Now in only her third year of professional practice, science is already changing the way new doctors are being trained to treat strokes.

“The way I was trained to treat stroke is not exactly how we do it today,” she points out. “A lot of treatment is evolving in terms of what drugs we give and how we give them. We have some powerful new drugs available. We’re looking at the old protocols and seeing how we can change them to get maximum benefit.”

One of the most promising changes is expansion of the “therapeutic window” during which drugs can be successfully given to break up a stroke in progress. Until very recently, that window of opportunity stood at six hours. But new MRI imaging techniques that can pinpoint the offending blockage, determine the extent of damaged brain and illuminate other brain regions at risk are pushing the window open wider. Even so, as the saying goes, “Time is brain.”

“I can dress pretty fast,” she notes. “For years, when I was a fellow and had to get there quickly to set everything up for my [attending physicians], I slept in scrubs. … I haven’t done that for a long time.”

Patients who arrive with a neurological emergency are moved quickly from the emergency room to the imaging rooms, where scans reveal the type and extent of damage, and help determine the best course of treatment. For some, surgery may be indicated; in some, intravenous medication will be best; for others, the solution will be a catheter guided gently through delicate blood vessels.

“This is very much a team approach,” Aagaard points out. “The decisions for treatment are made together with my stroke neurology and neurosurgical colleagues, all of whom are excellent.”

Especially for patients at the highest risk, the right decisions must be made within minutes.

“Every job has certain very stressful parts,” Aagaard remarks. “You have to like what you do. But in this job, you have to be able to make a quick decision and accept a certain amount of stress when you’re doing the procedure.”

Still, for job satisfaction it’s hard to beat saving someone from a devastating brain injury. Aagaard recalls one case in which a patient had a “huge” stroke affecting the dominant hemisphere of his brain.

“If we didn’t get this vessel open and perfuse his brain, he was going to complete a massive stroke and most likely die,” she recalls. “Within an hour of our treatment, he had all movement and speech back. Here’s a guy in his early 50s who should have died … but we were able to keep that person alive, with no neurological deficits, and keep his nuclear family intact. As his children grow older, he’ll be able to go to their weddings, dance with them, see his grandchildren. This is the part of medicine that’s just wonderful.”