Based on Maya’s National Institute of Health Stroke Scale (NIHSS) score, blood pressure, CT Angiography, the ED physician determines that Maya has suffered an ischemic stroke. The stroke may have caused damage to her brain, which is a part of the central nervous system. Fortunately, he was able to administer a tissue plasminogen activator (tPA) within the mandatory three-hour time period to try to break up the clot. However, she is not responding as well as the team had hoped, so after a consultation with a neurosurgeon, the decision has been made to perform surgery.

The ED physician explains to Maya’s daughter that Maya will be taken to surgery where a neurosurgeon will use Penumbra (an investigational technique) and insert a catheter through a small puncture in her groin. Then, using x-ray guidance, the device will be maneuvered through the blood vessels of the body to the site of the clot in her brain. A separator is advanced and retracted through the catheter to dislodge the clot and a suction device grabs hold of it for removal. To help clarify the procedure, the physician shows Maya’s daughter a quick animation of the Penumbra procedure. (See animation below).

The surgery is minimally invasive, but the physician warns that this could trigger another stroke because it may dislodge other clots or material that can then travel through the bloodstream and block an artery. However, the surgery could also help lower the risk of another stroke for several years. Time is of the essence because the surgery must be administered within eight hours of the first stroke signs. Because Maya cannot make a decision for herself right now, her daughter agrees that the surgery should be done.