New Therapies Save Stroke Patient From Double Trouble

Sep 23 2015

Retired accountant Daniel Purcell has two good reasons to be thankful for cutting-edge research and clinical treatment taking place in the Hunter. The 87-year-old Adamstown Heights resident endured two strokes within 15 months, was treated with different clot-removal therapies at John Hunter Hospital and made complete recoveries.

For the first stroke, which occurred while walking through a park, Mr Purcell was deemed a suitable candidate for the TASTE trial being led by HMRI researchers from the University of Newcastle and Hunter New England Health.

“Everything went a khaki colour and I remember thinking ‘am I dead or am I dying?’,” Mr Purcell said. “My next recall was waking up in the stroke ward.”

Administered a clot-busting therapy, Mr Purcell was able to leave hospital five days later then underwent 10 days of rehabilitation. He experienced no further side effects.

“Our group has really pioneered work in this area, using advanced imaging techniques to select patients who are suitable for the treatment,” Associate Professor Neil Spratt, one of the TASTE research leaders, said. “The trial is now being rolled out nationally and internationally.”

In August, Mr Purcell suffered his second, unrelated, stroke at home. This time, the clot was lodged towards the rear of his brain and doctors employed a revolutionary new retrieval system.

“Fortunately it’s relatively rare that people have a second stroke these days, because we’re pretty good at preventing them after the first one,” Dr Spratt said.

“The second stroke occurred in a different part of Mr Purcell’s brain, where it is difficult to dissolve blood clots. My colleague Dr Ferdinand Miteff inserted a catheter near Mr Purcell’s groin and passed it up the artery – the clot was then physically pulled out.”

The endovascular clot-retrieval procedure is a recent innovation evolving from research, with five separate trials showing it to be effective for acute stroke. Dr Miteff is one of very few neurologists in Australia currently trained to perform the procedure.

“Sometimes with bigger clots they just don’t dissolve in time to stop brain tissue from perishing, so technology improvements now make it possible to go into the big arteries and capture the entire clot and remove it in one sweep,” Dr Miteff said.

“It’s a bit like plumbing – if you have blocked pipes you can use a detergent but sometimes you need to physically unblock it. Same with the brain.”
In Mr Purcell’s case the second stroke affected an artery that often has a poor prognosis.

“They’re just brilliant,” Mr Purcell said of the stroke team. “I feel incredibly fortunate because they say three strikes and you’re out – well I’ve had two strokes and I’m still here.”

* The TASTE (Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation) trial is supported by the Greater Charitable Foundation, National Heart Foundation and National Health and Medical Research Council. Associate Professor Neil Spratt and Dr Ferdinand Miteff work with the Hunter New England Health Acute Stroke Service, researching with the University of Newcastle in conjunction with HMRI’s Brain and Mental Health Program. HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.