Neurointerventional Radiology Saves Stroke Patient

Stroke Survivor Kevin TuckmanIn September 2021, Kevin Tuckman, a 48-year-old sales manager, was doing a demo for a potential client in Foster City when he started having difficulty talking. "I would want to say something, and some words came out, but others I couldn't say," Tuckman said. After he dropped his pen five times within a one-minute period, Tuckman's colleague, Melissa Jackson, asked him if he was OK. "I remember looking at Melissa, taking a deep breath and saying, 'Give me a minute.'" He continued to discuss the digital technology he was trying to sell, going over numbers and figures, but his math was completely wrong. Eventually, Jackson said: "You aren't OK, we need to take you to the hospital."

After they left the meeting, Jackson called Tuckman's fiancée Karla Wargo who said: "Take him to UCSF." For Wargo, who grew up in San Francisco, UCSF is always her first choice for loved ones in need of medical attention. "I know UCSF leads the way in so many areas of medical care."

Stroke therapy and intervention are among the most successful advances in medical history, according to Matthew Amans, MD, MSc, an associate professor of clinical radiology, who ultimately treated Tuckman. "You can take someone who's dying and not only save their life, but often allow them to be normal, functioning members of society within 30 minutes," Dr. Amans said. "It's an incredible revolution in medicine that's only happened within the last 10 years." His group in neurointerventional radiology treats about 150 stroke patients per year.  (In fall 2022, the Neurointerventional Radiology faculty joined the Neurosurgery Cerebrovascular Surgery faculty to establish Neuroendovascular Surgery (NES), a new transdisciplinary service line.)

When Tuckman arrived at the hospital, he and Wargo were brought to triage where tests were conducted. "We were waiting in the ER for a room, and I was sitting on a bed in the hallway with Karla," Tuckman said. A nurse came over and asked him to put his hands up, but he didn't understand what she said. "At that moment, I thought this was my new life – not being able to communicate anymore," said Tuckman, who is a father to 13-year-old twin boys. "I thought my life was over as I knew it." For one of the rare times in his life, Tuckman broke down in tears.

But he didn't have time to dwell on it. "Once they thought it was a stroke, I remember hearing 'code stroke,' and within about 30 seconds I had 15 people on top of me." Tuckman said he was immediately placed on a gurney, had an IV placed and rushed to the angio suite. For every minute that the blood vessels close in the brain, it's estimated that 1.9 million neurons are damaged permanently.

An occlusion of a blood vessel in Tuckman's brain caused the downstream brain to not function properly. "If left untreated the survivability from that is very low," said Dr. Amans. Using an X-ray camera, Dr. Amans and his team guided their tools, starting in the groin and up through the blood vessels, to the brain. They saw that in the neck there was no flow in the carotid artery and there was a clot sitting in the blood vessel in the neck extending all the way up and into the brain. They deployed a stent fused to a wire within the clot and pulled the clot down and out of the body reopening the blood vessels in the brain. All of this was done from inside the blood vessels (as it always is), making it a minimally invasive procedure. In other words, the skull does not need to be surgically opened to access the clot.

Tuckman was awake during this procedure because general anesthesia can worsen an injury to the brain. Once the clot was removed, Tuckman was able to speak again. "I remember at one point, I told them it hurt," Tuckman said. The doctors told him the pain would subside quickly, and it did. "Before that, I had lost the ability to speak."

After the clot was removed, Dr. Amans turned his attention to Tuckman's problem in the neck. The clot had come from a dilated and injured segment of the carotid artery in the neck. Leaving that blood vessel as it was, would send another clot downstream and he'd be back in the same life-threatening situation. At this point, Dr. Amans had two options: He could use a series of stents, a big construct of tubes to try and open up the blood vessel — or — he could close that blood vessel off entirely. Both options carried the risk of a second stroke.

To make the decision Dr. Amans and his team (including the vascular neurology Fellow) did a physical exam on the operating table. They checked Tuckman's neurological function to see if his brain was working after they had restored the blood flow within the head.

"He had started to recover immediately on the table after we reopened the blood vessel in the brain," Dr. Amans said. "Since he was recovering, we figured he probably didn't need the severely diseased blood vessel in the neck in order for his brain to survive. We made the decision to sacrifice the blood vessel in the neck, and we sealed it off with a few coils."

For some surgeons, the more intuitive therapy in a case like this would be to install a series of hardware stents to restore the blood flow to the vessel, but in this situation it would have been more dangerous, Dr. Amans said. "While it's not the most intuitive therapy to deconstruct the vessel, it's sometimes the better therapy." Placing a series of stents likely would have pushed more blood clot downstream into the brain circulation. The entire procedure was minimally invasive and completed in about 30 minutes. "The only way you can do something with that level of efficiency is to have a really good team of people who are highly trained to work in parallel and do our jobs at the same time," Dr. Amans said. "That's what allows for the very rapid restoration of blood flow to the brain, even in the most complex patients."

About two years earlier Tuckman dove three-to-four feet off a pontoon boat into a lake. "I hit the water wrong," Tuckman said. "I remember coming out and noticed my hand was a little numb." He even sought out medical care for nerve testing, but medical staff couldn't find anything wrong. That dive likely damaged his carotid artery, which caused the blood clot.

Today, aside from the occasional miscommunication of words — for example, saying "season" instead of "game" — Tuckman is essentially back to normal and feeling great. "I feel like I won the lottery," Tuckman said. "I'm living my life again." He spent six days in February skiing and hiking with his sons at Lake Tahoe. In November 2022, he married Wargo. Their first wedding was postponed because of COVID, their second wedding was postponed in 2021 because of his stroke, but Tuckman said their wedding in November 2022 would have happened no matter what. "Come hell or high water, we were getting married!"