Quick Action Helps Patient Make Remarkable Recovery From Stroke

In less than 40 hours, Mary Ciancibello goes from major stroke to returning home feeling fine

Life can change in an instant, so cherish each moment.

The wisdom of that saying became evident for the Ciancibello Family of Mentor, Ohio, in the early morning hours of Jan 31.

Leslie (Les) Ciancibello was sound asleep after a long day of work as a supervisor in radiology at University Hospitals Seidman Cancer Center. His wife, Mary, who works as a lactation consultant at UH MacDonald Women’s Hospital, was beside him.

Their oldest daughter, Kaela, was prepping for a colonoscopy during the night. They knew she would be up at night. In fact, Mary, being the good mother that she is, had said to Kaela, to wake her up when she completed the prep at about 3 a.m. in case she needed anything.

“My daughter woke her up, and they were milling around doing some things, and my daughter noticed that something didn't seem right,” said Les. “Kaela saw something was off, and when she really looked at Mary, she had a facial droop.”

Kaela flew up the stairs, woke up Les, and said there was something wrong with Mom. Les, groggy from sleep, asked what she meant, then asked her to turn on the light. He saw Mary standing there with complete facial droop.

“Okay, we're calling the squad,” Les said. “Mom is having a stroke.”

Les sat Mary on the bed, and did a neuro check, based on his experience in medicine.

What’s your name? What's the date? What month is it? Who's the president?

And she just sat there staring at him. “I'm like, ‘Oh, wow, God,’ ” said Les.

EMS confirmed Les’ suspicion and drove her to UH TriPoint.

The TriPoint Emergency Department did an emergent head and neck angiogram. They found Mary had a dissected left carotid artery, or a tear in an artery in the neck, and a blockage in the middle cerebral artery – the most common artery involved in acute stroke.

Mary was taken to UH Cleveland Medical Center about 6 a.m. where the stroke team was standing by.

She was quickly taken for a CT perfusion study, a CAT scan interventional neurologists use to determine how much brain is still viable versus how much brain may have been lost from the stroke.

The neuro team needed to assess if it could safely remove the blockage from her artery through a procedure called a mechanical thrombectomy. If too much of the brain is already lost from the stroke, releasing blood back into that region of the brain runs the risk of significant bleeding.

“We quickly found out, thanks to the amazing technology called RAPID that we have here at UH, that 75 percent of her brain was at risk for death,” Les said. “But it was still good. It was still viable. It was still getting enough oxygen to maintain itself, and only a very, very teeny part of her brain was lost.”

The procedure was performed by UH neurosurgeon Abhishek Ray, MD, and radiology interventionalist Jeffrey Sunshine, MD. It took less than 90 minutes.

“Mary had a left carotid dissection in the neck, where there is injury to the inner wall of the blood vessel. This can cause occlusion (or blockage) of the vessel and clot formation that can then travel farther and cause more distal occlusion of blood vessels in the brain,” said Dr. Ray. “We call this ‘tandem occlusion,’ where there is occlusion of the carotid artery and the middle cerebral artery as well, which supplies majority of that side of the brain.”

Dr. Ray said these cases are often more difficult to treat because the doctors have to first open up the carotid blockage and find the true opening of the blood vessel to get the catheters and devices through to open up the next blockage. Sometimes, they have to use stents to keep the dissected carotid artery open, but they did not need to do so in Mary’s case.”

“We were able to open up both the internal carotid artery and the middle cerebral artery with near-complete recanalization of all the middle cerebral artery branches. When I told Les this after the procedure, he was so happy that he started crying and gave me and Dr. Sunshine big hugs, which was very emotional and rewarding,” said Dr. Ray.

Following the procedure, Mary was taken to the Neurological Surgical Unit (NSU) for recovery. For the next four hours, the NSU team watched for any signs of brain bleed.

For Les, the time was excruciating because Mary did not know where she was and could not talk.

“Every 15 minutes for four hours, we had to tell her where she was, we had to tell her her name, and, as time went on, I was just like, ‘Oh, my God, is this ever going to get better?’” Les said.

“The NSU teams were amazing, and they kept reassuring me that she was going to get there.”

Mary slowly got better throughout the day. She was able to eat some food. But she would try to say some words, and the sentence would start with two or three words that made sense, then sail off into nothingness, said Les.

He finally got some sleep that night, 19 hours after the stroke. The next morning, he rushed to UH Cleveland Medical Center and found Mary sitting up in bed, eating breakfast and watching TV.

“I walked in the room, didn’t even say hello, just said, ‘What's my name?’” Les said. “And she just looked over at me, and she's like, ‘Leslie Ciancibello. Why?’ And I’m saying, ‘Oh my God, I've been waiting to hear you say that for 24 straight hours.’”

The NSU team said she was making a great recovery. Les is grateful to his wife’s care team, especially Kelly Montgomery, Stroke Center Supervisor, and Amrou Sarraj, MD, Director, Cerebrovascular Center and Comprehensive Stroke Center and Mary’s inpatient stroke attending physician.

Mary was able to go home by late afternoon on the second day.

Dr. Ray said Mary made a remarkable recovery. “When I saw her in follow-up, she had no deficits. It’s like nothing ever happened. Really the only thing she was bummed out about was that she couldn’t go on roller coasters anymore, which is a general recommendation we have for patients who have had carotid dissection or at risk of one. I think Les’s awareness of stroke and quick-thinking saved Mary’s life just as much, if not more, than our intervention,” said Dr. Ray.

What caused Mary’s stroke? She did not have the usual risk factors of high blood pressure or high cholesterol. Through brain imaging, the neurosurgeons found that she has fibromuscular dysplasia (FMD), which, is a rare vascular disease that causes abnormalities of the blood vessel wall including a “string of beads” appearance of arteries as well as artery dissections. Mary’s subsequent scans show that she has no other abnormal vessels outside of the carotid artery.

Mary is seeing Heather Gornik, MD, Co-Director, Vascular Center, Harrington Heart & Vascular Institute and Director of the UH FMD and Arterial Dissection Program for this. According to Dr. Gornik, “it has been shown that FMD is an important underlying cause of carotid artery dissection, especially in women. Fortunately, with continued follow-up and medical care, however, Mary’s prognosis is excellent.”

Mary and Les recently celebrated their 30th anniversary in Hawaii five months early, but who can blame them?

“This really was kind of a miracle in of itself, the way it all panned out,” said Les. “It's really been a remarkable recovery.”