Inova Heart and Vascular Institute is the first U.S. hospital to offer certain technique to help prevent certain strokes
When nestled in the womb, every baby has a small, strategically located hole between the left and right chambers of their heart. This hole allows blood to bypass the still nonfunctioning lungs and carry oxygen straight to the fetus’s heart and brain. For about 75 percent of people, the space seals after birth. However for some, the hole remains, forming a patent foramen ovale (PFO). Usually, a PFO causes no health consequences, but for some people, the defect is dangerous.
“Normally, if a small blood clot forms in your vein, it travels through the right side of your heart and into the lungs, where the clot is filtered out,” explains James Thompson, MD, interventional cardiologist at Inova Fairfax Medical Campus (IFMC) . “But if that clot pops through your PFO, it can travel up to your brain and cause a stroke.”
Almost half of those who have a stroke before age 55 and without any identifiable risk factors have a PFO, according to the American Heart Association. That amounts to about 100,000 Americans who suffer a PFO-related stroke every year.
What is NobleStitch?
The NobleStitch™ is a brief, minimally invasive procedure that closes PFOs. While the U.S. Food and Drug Administration (FDA) has approved it for use in the heart, the technique is not specifically labeled for treating PFOs. Inova Heart and Vascular Institute (IHVI) is the FDA’s principle investigation site to evaluate the procedure’s effectiveness for closing PFOs in people who have already had at least one stroke. That makes Inova the first U.S. hospital to perform the NobleStitch.
Results, emphasizes Dr. Thompson, who is leading the clinical trial, are encouraging. “I have not been this excited since medical school. Noble-Stitch technology is so innovative, with recent studies published in the New England Journal of Medicine showing us up to a 97 percent reduction in risk for recurrent stroke with PFO closure versus standard medical therapy alone. The number of lives we can positively impact is amazing,” he points out.
A fresh start for migraine sufferer
Among those positively affected is Dina McPherson, a film and television screenwriter and producer in Melbourne, Australia.
Dina had long suffered severe migraines that involved blind spots, flashing lights and other debilitating symptoms. After a particularly frightening aura, Dina called her GP and, after a slew of tests, a PFO was identified. The PFO likely could cause a stroke. With that, Dina began researching PFO, and that led her to NobleStitch and Dr. Thompson, who references medical literature that shows evidence of improvement of migraines in patients undergoing PFO closure for stroke. In June 2018, knowing this revolutionary technique was the right choice for her, she flew more than 22 hours to IHVI, which is part of IFMC.
“As soon as the procedure was over, I no longer felt my heart flopping in my chest. And recovery was rapid. I had a heart procedure one morning and was sightseeing the next day,” Dina recalls.
Today, Dina remains an ardent NobleStitch fan. “There are no words to express what it has meant to me — to be free of stroke, free from my migraines and free from [the possibility of] a permanent metal device in my heart,” she says. “Now I just hope that my case brings a new awareness to the doctors here in Australia.”
Specialized stroke care expertise
Because a stroke blocks or reduces blood flow to the brain, every second is precious for a stroke patient.
Inova Fairfax Medical Campus, certified as a Primary Stroke Center, is one of the country’s few hospitals that provides a higher level of comprehensive, multidisciplinary stroke care 24/7/365. “Being qualified to perform a mechanical thrombectomy at a high level differentiates our hospital,” stresses Edward Greenberg, MD, neurointerventional radiologist. “That means we guide a long, thin tube called a catheter into the blocked artery within the brain and use approved devices to restore blood flow. However, sometimes administration of an intravenous clot-busting drug alone — tPA — is the best choice. Both solutions have time constraints. It takes swift, interdisciplinary action between our experts to determine the best move forward.”
The expert team involves emergency room (ER) doctors; a dedicated ER stroke nurse; a neurologist, available 24/7, who assesses tPA appropriateness; neuro-critical care, who evaluate patients for mechanical thrombectomy; in-house neuroradiologists, who perform and interpret advanced imaging; and the critical care team.
“Timing is everything,” Dr. Greenberg says. “With our deep, interdisciplinary stroke team, we can quickly react to each patient’s unique circumstance.”
Time Is Brain When It Comes to Stroke