Cutting-edge devices may change stroke treatment.

Byline: THE HEALTH FILES by Tim Christie The Register-Guard

ON THE MORNING OF Aug. 23, 2000, Jack Hayes was talking on the telephone when he turned to his wife, Carol, and said, "The damn thing don't work." Then he dropped the phone and found himself unable to speak.

Jack Hayes was having a massive stroke. A blood clot the size of a Tootsie Roll was blocking an artery, cutting off blood flow to his brain.

Hayes, of Castle Rock, Wash., was rushed to the hospital in Longview, Wash., where doctors had just heard about an experimental stroke treatment at Oregon Health & Science University.

He was put in another ambulance and rushed the 100 miles to Portland.

There, doctors snaked a slender catheter through an artery until it reached the blood clot in his brain that was causing the stroke, and pulverized the clot with ultrasound waves and stroke medication until it broke up.

Today, Jack Hayes, 66, appears no worse for wear, his wife said. He chops wood and shoots his muzzle-loaded pistol and betrays no sign that he came so close to dying.

"We've got a miracle walking around here and we know it," she said.

Hayes, a retired supervisor at the Weyerhaeuser plywood mill in Longview, was on the receiving end of a cutting-edge treatment for strokes.

The only treatment for strokes now approved in the United States is the drug t-PA, which is given intravenously and acts something like Drano to dissolve a clot. But if administered more than three hours after a stroke, its effectiveness diminishes and it can actually increase the chance of cranial bleeding.

About 50 percent of stroke patients treated with t-PA recover fully, but patients who suffer severe strokes have only an 8 percent chance of significant improvement on t-PA, according to an article on the Web site eMedicine.com.

Now a number of companies have developed catheter devices that use lasers, ultrasound or saline jets to break up clots, eMedicine.com reports. Several devices are now in clinical trials, with the companies hoping to win approval from the Food and Drug Administration.

Doctors at OHSU's Oregon Stroke Center have been testing one of those devices, developed by a Bothell, Wash., company, that simultaneously delivers t-PA and ultrasound waves to break up a stroke-inducing clot. The ultrasound energy is thought to allow the drug to penetrate more efficiently into the blockage, according to the company, EKOS Corp.

The Oregon Stroke Center was the lead site to test the device on humans in a clinical trial. Six of 14 patients who participated in the trial were treated there.

"Overall, it was positive," said Dr. Wayne Clark, Oregon Stroke Center director. "We couldn't open all the clots. We were focusing on really big clots."

About two-thirds of the patients experienced complete or partial breakdown of their blood clots. Three months after treatment, nearly half the patients showed enough improvement to function independently.

Treating the clots with both ultrasound waves and the drug t-PA worked better than using t-PA alone, Clark said. Also, the experiment doubled the window during which a stroke patient can be treated, from three hours to six hours.

EKOS Corp. is about to begin the third and final phase of testing its device, Clark said. It plans to try it on 100 stroke patients around the country in a study expected to last several years.

Strokes hit half a million Americans each year and kill about 150,000. Stroke is the third-leading cause of death in the United States and the leading cause of disability. About 8,000 Oregonians suffer strokes each year.

In 80 percent of strokes, a blood clot clogs an artery, blocking the flow of blood to the brain, which can cause brain damage. Smoking, high blood pressure and diabetes are the three main risk factors.

Untreated, stroke kills about one-third of its victims and puts another third in nursing homes.

Doctors told the Hayes family that Jack Hayes almost certainly would have died if he hadn't been treated with the new treatment, Carol Hayes said.

He was in the hospital five days, and doctors insisted he use a walker at first. He doesn't remember the three weeks after the stroke.

He underwent open heart surgery 12 weeks after the stroke, which improved the oxygen flow to his brain.

But there are few clues that Jack Hayes nearly died from a massive stroke. After extensive speech therapy, he speaks well, though sometimes it takes him a moment to find the word he's seeking. If he walks too far, he limps a little on his right leg, said his daughter, Debbie Robbins of Toutle, Wash.

"He went from a man who couldn't swallow to a man who was doing everything he did before," she said. "I pretty much have to make him slow down, make him listen to his body."

Jack Hayes couldn't make it to the phone to comment. His wife said he was out in the canyon behind the house, chopping wood.

Tim Christie covers health and medical issues. Call 338-2572 or e-mail [e-mail].