Joseph Annunziata, an 80-year-old Army veteran from Long Island, New York, says he isn’t exactly proud of his story, but hopes that by sharing it he can help others. For years his doctors had warned him about a narrowing left carotid and encouraged him to undergo an endarterectomy—a procedure to remove buildup in his artery and hopefully prevent a serious stroke. Unfortunately, on the morning of Veterans Day 2022, his decision to put off the procedure finally caught up to him.
“I was going to the store which is five minutes away and my right hand went limp. Then all of a sudden my speech went slurry and I knew I was in trouble. So what I did was turn the car around and I drove down to the Northport VA... although I know I shouldn’t have done that,” said Joseph.
Upon arriving at the VA, Joseph was immediately sent by ambulance to their partners at the Stony Brook Cerebrovascular and Comprehensive Stroke Center where he was evaluated by neurointerventionalist Dr. David Fiorella, stroke neurologist Dr. Jason Matthew, and their team.
Joseph underwent a series of scans which indicated a small completed stroke and an occluded left carotid. With a National Institute of Health Stroke Scale (NIHSS) score of 6 and only mild stroke symptoms, many care teams may have chosen to observe him for 24 hours.
However, using Rapid CTP to quickly analyze Joseph’s CT perfusion scan, Drs. Fiorella and Matthew were able to quickly and clearly see the severity of the reduction in blood flow including the volume of tissue affected. They could see the blockage was putting almost half of Joseph’s brain at risk. With the clinical context provided by Rapid CTP, they felt even more confident that if they did not intervene the infarction would be significant and Joseph’s condition would likely deteriorate fast.
But, given the complicated nature of the intervention, the decision whether or not to move forward was not so simple.
“There was a carotid filled with clot and occluded from atherosclerotic plaque, so it was a situation where the stakes were incredibly high. It was one of those cases where you certainly could make things a whole lot worse by intervening,” said Dr. Fiorella. “The decision we ultimately made was based largely on data from the RapidAI perfusion imaging. To have perfusion data say that this patient has a 200CC area of potential at risk, it helps give you that confidence that it's important to intervene."
Fortunately, Stony Brook University Hospital is one of few hospitals in the country to pioneer a special sequential balloon inflation technique used to safely and successfully revascularize complete carotid occlusions. Just 90 minutes after Joseph arrived at the hospital, he underwent treatment and only hours later emerged from anesthesia with major improvements in his condition. Four days later, he walked out of the hospital and returned to his home.