Preventing Another Stroke With a Single Stitch
By Jessica Levco
Evelyn Conick, a 67-year-old Carol Stream, Illinois, resident, suffered from a stroke back in late 2015. Her doctor couldn’t figure out why she had one. But because she did not have any of the common risk factors for stroke, such as high blood pressure or cholesterol, tobacco use or a family history of stroke, the doctor said he was 95 percent sure she wouldn’t have another.
Unfortunately, he was wrong. Conick had a second stroke in February 2019. And it turns out that the cause of both strokes was something she was born with.
A scary discovery, a life-saving decision
Between the two strokes, Conick learned that she had a hole in the back of her heart.
This opening is called a patent foramen ovale (PFO). It’s present in all babies during development in the mother’s womb, but closes when the baby is born. Most of the time, it’s a benign condition. In fact, 25 percent of the U.S. population has a PFO.
However, for some people — small blood clots can cross through the PFO, go up into the brain and cause a stroke.
After recovering from her second stroke, Conick knew she could not risk a third. She decided to get her PFO closed. And she turned to Clifford J. Kavinsky, MD , PhD, an interventional cardiologist at Rush University Medical Center, who offers a novel PFO closure procedure called Noble Stitch.
Exploring a connection between PFO and stroke
Rush is a Center of Excellence for PFO closure procedures, and Kavinsky has long been interested in the possible connection between PFO and stroke. Several randomized clinical trials have looked at patients under 65 who have had a stroke with no identifiable cause. What did all those patients have in common? They all had a PFO.
With Noble Stitch, the physician is able to use a single stitch to close a PFO. The traditional PFO closure approach uses an implanted metal device that stays in the heart’s muscle. It's an effective way to close the PFO, but sometimes, a blood clot will form on the device and cause an infection.
“Noble Stitch is considered a no-footprint procedure,” says Kavinsky. “There’s nothing left behind in the patient’s heart that could cause a complication.”
Leading the ‘Noble’ effort
Kavinsky and his colleagues at Rush were the first in Chicago to offer Noble Stitch. They have performed eight Noble Stitch procedures as of November 1, 2019, and are participating in a clinical trial in Fall 2019 looking at the effectiveness of the stitch in closing the PFO.
The early results have been encouraging. Most of the Rush Noble Stitch patients no longer have to be on blood thinners, which are needed to prevent clots in people who have the implanted device. Kavinsky also says that Noble Stitch greatly reduces their risk for a second stroke — or, in Conick’s case, a third.
“I can’t believe he did this with one stitch,” Conick says. “It’s so much better than having a device in my heart. I was so fortunate that Dr. Kavinsky was my doctor. I think the world of Rush and their doctors.”