Malcolm Daly knows a thing or two about survival. The experienced climber lost a leg to frost bite following a climbing accident on the Alaska Range in 1999. In the two decades since then, Daly, 65, has also endured multiple strokes and a heart attack. His survival skills were most recently put to the test in April 2020 when he suffered his third stroke. Luckily, he had a team of dedicated healthcare professionals, equipped with cutting-edge technology, on his side.
Daly’s stroke occurred in his home in Hailey, Idaho, where he and his wife, Karen, had moved just two weeks before from Colorado. Following an afternoon bike ride, Daly decided to take a nap. He remembers not being able to move anything on the right side of his body shortly after lying down. Karen checked in on him a few minutes later and, realizing her husband had a stroke, called 9-1-1.
Daly was transported by EMS to St. Luke's Wood River Medical Center in nearby Ketchum, Idaho, where non-contrast CT, CTA and CT perfusion scans were quickly ordered. Molly Gill, a nurse in the emergency department at Wood River, was part of the team that met Daly upon his arrival. “He presented with some of the most severe symptoms I've seen in my career. Basically, the entire right side of his body was non-functioning,” Gill said, recalling that she had to use her body to pin his right arm against the CT-scanner bed when starting his IV because it kept falling off the bed. Daly, who was also unable to communicate verbally, was determined to have a National Institute of Health Stroke Scale (NIHSS) score of 24. His condition was severe and would have to be treated quickly if he was going to recover.
Wood River Medical Center is a rural critical-access hospital with no urgent on-site neurology expertise, so patient scan results typically have to be reviewed by an on-call radiologist at St. Luke’s Boise Medical Center more than 150 miles away; the fact that the health system is equipped with the Rapid® imaging platform, however, meant that Daly’s results were delivered automatically to stroke specialists. The entire Boise stroke team was notified immediately as soon as the results were available, regardless of where they were at the time. “I got a notification on my phone, and I immediately looked at it,” said neurointerventional surgeon Dr. Tony Bell. He was also able to view the RapidAI results from Daly’s CT scans directly from his mobile phone using the Rapid Mobile App. “I saw that this was someone who was going to need help, so I immediately started making preparations to get people activated and talking to the teams at the transfer center and Wood River,” Bell said.
Daly’s RapidAI results revealed that he had a large vessel occlusion of the left internal carotid artery and proximal middle cerebral artery. The call was made to airlift him from Wood River to Boise where Bell would perform a mechanical thrombectomy to remove the clot blocking blood flow to Daly’s brain. Even with the time it took for the helicopter to arrive—typically 45 minutes—the team at Wood River achieved a record-breaking “door-in, door-out” time of 81 minutes.
Once in Boise, Bell completed the thrombectomy, which successfully restored blood flow to Daly’s at-risk brain tissue, in approximately 30 minutes. He was able to leave the hospital two days later with a NIHSS score of 2. Bell chalks up the success of the procedure to one simple factor: time. “If it had taken another hour to get the clot out, I don't think he'd be doing as well as he is,” Bell said.
Now two months after his third stroke, Malcolm Daly is more or less back to his active lifestyle, following a period of intensive speech therapy. He’s managed to channel some of his survivor’s grit into daily bicycle rides, and he’s even planning another climbing trip with friends.