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Room with a View

Posted on January 12, 2017

When interventional radiologist Keith Woodward, MD, repairs an aneurysm, Adam Hill stands beside him and hands him the instruments.

But on a recent November afternoon, Adam, who works in the interventional radiology lab at Fort Sanders Regional’s Comprehensive Stroke Center, was in a different position. He was Dr. Woodward’s patient.

A brain aneurysm in an artery near his right ear had ruptured several hours earlier, causing a subarachnoid hemorrhage and giving Hill a 13-day hospital stay with a close-up view of Fort Sanders Regional’s heralded stroke care.

The night it happened Hill was “on call for strokes,” but when a call came around 3 a.m., the young father of two was battling what he described as “the worst headache I’ve ever had.” Although he recognized that as a symptom of an aneurysm, he thought he was “just being paranoid” and brushed the possibility aside. After all, headaches and nausea were not uncommon for him.

Hours passed; the pain didn’t. When he saw that his balance was also “off,” Hill’s suspicions of a cerebral hemorrhage grew. Those suspicions were shared by emergency room physician, Douglas Campbell, MD, after Hill and his wife Melissa arrived at the Fort Sanders Regional Emergency entrance around 11:15 a.m.

Dr. Campbell quickly ordered a computed tomography angiogram (CTA), telling Hill, “If that comes back negative, we’ll do an LP [lumbar puncture or ‘spinal tap’] and go from there.”

He knew that if it was an aneurysm, Dr. Woodward would likely be treating him. “I work with Dr. Woodward and I’ve seen him do some unbelievable stuff,” Hill said. “He’s helped patients who had no hope and he would bring them back. I knew what that man was capable of. He’s a good man, a good friend and a good doctor. I trust him.”

Just minutes after the scan confirmed a 4mm aneurysm on Hill’s brain, Dr. Woodward was face to face with his assistant-turned-patient. “I was shocked,” said Dr. Woodward, who has performed about 1,000 aneurysm repairs in 13 years of practice. “Normally, Adam would be assisting me, prepping and handing me the coils and ensuring the syringes used in the procedure do not contain air bubbles.”

But if Dr. Woodward was shaken, it didn’t show as he performed an embolization using a technique known as endovascular coiling. The procedure accesses the femoral artery through a tiny incision in the groin. The radiologist uses a wire to guide the catheter through the aorta, up through the neck and into the site of the aneurysm. The guide wire is then removed and a contrast dye injected via the catheter to give clear radiographic images of the artery and aneurysm.

A microcatheter is then slipped into the larger catheter and used to carry spring-shaped platinum coils about twice the thickness of a human hair into the aneurysm. The coils are then “packed” into the sac, forming a mesh similar to steel wool. Blood cells are caught and clot on this mesh, sealing off the aneurysm from the artery circulation.

“Dr. (Scott) Wegryn (a radiologist colleague of Dr. Woodward) was watching the procedure and he said it was one of the best procedures he ever saw Dr. Woodward do,” said Hill “He said it went smoothly – it was so perfect; there were no hiccups. He said Dr. Woodward got right up there, pulled it off, closed me up and sent me off to the Neuro Intensive Care Unit.”

A post-procedure checkup by occupational and physical therapists determined that Hill had not only survived his aneurysm rupture (50 percent of patients do not) but did so with no disabilities or deficits. Still, because younger patients are more susceptible to vasospasms, a dangerous after-effect of a rupture, he remained hospitalized at Fort Sanders Regional for 13 days as they kept close watch on him.

“The care I received was beyond excellent,” he said. “It was the best care I’ve had in my life. It was amazing. I was treated like a king.”

As Hill recovered in the hospital, he began to see his ordeal in a new light. “I got to see the whole perspective of the patient and that’s the best part,” he said. “We only get to see the patient for the procedure, but we never see them in the units, and once they leave … there are a lot of things they have to go through to get out the door. A lot of things have to line up just right. I got to see that part of the picture.”