Quick stroke treatment and innovative heart surgery by UTHealth Houston allow stroke survivor to return to health

Brenton Parr had felt dizzy like this twice before. But this time, early in the morning, as he looked out of the window of a spare bedroom to check the weather before heading to the gym, it was far worse.

“I felt as though the whole room and world were starting to spin around me, and I thought, ‘I need to get on the floor right now,’” said Parr, 57, of that moment the morning of Feb. 4. “I realized that whatever was happening this time was at a more intense level than before. I couldn’t see very well, so I was squinting.”

His partner found Parr crumpled next to the window a few minutes later.

“I think I am having a stroke,” Parr told him. “He told me to go sit on the sofa, and I said I couldn’t get to the sofa and needed medical attention immediately.”

A series of events unfolded, beginning with treatment in his driveway by a mobile stroke unit, to a handover to a UTHealth Houston neurology stroke team, and culminating with heart surgery to correct a birth defect believed to be the cause of the stroke.

Parr was aware that the nurse on board Houston Mobile Stroke was in contact with UTHealth Houston stroke specialist Andrew Barreto, MD, MS, associate professor in the Department of Neurology in McGovern Medical School at UTHealth Houston. Barreto is with the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases and part of the UTHealth Houston teleneurology team, which has been providing acute telestroke and teleneurology services in Texas for 18 years.

Barreto ordered the clot-buster tenecteplase after the mobile stroke unit’s computed tomography (CT) scan revealed an ischemic stroke, where a blood clot has lodged in an artery, depriving blood and oxygen to that area of the brain.

Every 40 seconds, someone in the United States has a stroke, according to the Centers for Disease Control and Prevention. Most of those, 87%, are ischemic strokes like the one Parr had. Stroke is the fifth leading cause of death, resulting in 165,393 deaths each year, and a leading cause of disability.

Parr’s symptoms were not the classic ones that most people associate with stroke using the FAST acronym: Face drooping, Arm weakness, and Speech difficulty, with the T representing Time to call 911.

But dizziness, confusion, trouble seeing, trouble walking, and severe headache are other symptoms, according to the American Stroke Association.

Parr, who exercises regularly and has no other health issues, sought medical help after two previous milder episodes of dizziness in 2022, and was diagnosed initially with vertigo. When it happened the second time and disappeared after a few minutes, he thought it was no big deal. 

This time was very different.

At Memorial Hermann-Texas Medical Center, the team from Houston Mobile Stroke handed him off directly to a team led by Sishir Mannava, MD, assistant professor of neurology and associate program director of the Vascular Neurology Fellowship Program at McGovern Medical School. With him was the vascular neurology resident on call, Glauco Cesario, MD, and the vascular neurology fellow on call, Jacob Sambursky, MD. They met at the stroke stop sign hung on a call near the operating room area, where stroke handoffs occur if patients need to be rushed into surgery. Since a stroke kills 1.9 million neurons a minute, time is brain.

“The clot was identified in the basilar artery, one of the most dangerous for a blockage because it supplies the brain stem and back of the brain, the part that allows us to live,” Mannava said. “We realized Mr. Parr was having a lot of fluctuating symptoms, including vision loss, weakness, and slurred speech, which told us the clot was not yet fully resolved.”

Mannava’s team conferred with the endovascular neurosurgery team, counseled Parr about what was occurring, and through a cerebral angiogram, was able to tell the clot was smaller, but not gone. The good news is that the clot could be retrieved via a catheter inserted through the groin by the endovascular neurosurgery team.

“We worked closely with the emergency medicine and endovascular neurosurgery team at Memorial Hermann-TMC to make a direct-to-neuroendovascular thrombectomy process,” Mannava said. “Patients are triaged quickly, but safely so we can get them to stroke surgery sooner.”

Parr remembers talking to Mannava about the endovascular thrombectomy, which was led by Peng Roc Chen, MD, professor in the Vivian L. Smith Department of Neurosurgery, director of the Cerebrovascular and Endovascular Program, and Memorial Hermann Chair at McGovern Medical School. He was assisted by endovascular neurology fellow on call Salvatore D’Amato, MD.

Chen is part of UTHealth Houston Institute for Stroke and Cerebrovascular Diseases. 

“When I woke up at 3 p.m., I could open my eyes and see clearly and I could speak normally. In short order, I got up and could walk around,” Parr said. “So I was aware of the fact that whatever was done was fast and cleared out the clot.”

During his two-day inpatient stay, Parr underwent imaging of his heart as doctors sought to find out why this healthy, relatively young man suffered a stroke. What they discovered was a patent foramen ovale (PFO), a hole between the left and right atria of the heart. It exists in every baby before birth and usually closes shortly after birth, but in about 25% of people, it remains open.

There are no symptoms of a PFO, and a majority of people don’t even know they have one. But in some cases, a blood clot can travel from the right atrium to the left and then to the brain, causing a stroke.

Two weeks after he was released from the hospital, Parr was seen at the UTHealth Houston multidisciplinary Heart Brain Program, which allows a patient to be treated by a cardiologist and a neurologist at the same time. He met with Anjail Sharrief, MD, MPH, associate professor and director of Stroke Prevention with the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases, and Abhijeet Dhoble, MD, associate professor of interventional cardiology with UTHealth Houston Heart & Vascular and director of Structural Heart Interventions.

“Brenton had a large PFO diagnosed on the echocardiogram,” Dhoble said. “If a PFO is not closed, patients have a 67% chance of having another stroke.”

Dhoble enrolled Parr in a multicenter clinical trial, called OCCLUFLEX, comparing the PFO outcomes of a new percutaneous PFO closure system to the standard-of-care occlusion. Parr also enrolled in the VIRTUAL study (Video-based Intervention to Reduce Treatment and Outcome Disparities in Adults Living with Stroke or TIA), a study led by Sharrief at UT Health that engages a multidisciplinary team to provide post-stroke care using telehealth and remote blood pressure monitoring.

“I had done some research, and knew I wanted the hole patched,” Parr said. “We were all aligned on what needed to be done.”

Just before Easter, Dhoble, along with Muhammad Khan, MD, cardiovascular disease fellow, performed the surgery. After one night in the hospital, Parr was back home.

Parr still has some residual symptoms, including numbness on one spot of his face and at the tips of two of his left fingers. But he has returned to the gym, working out once more on the rowing and elliptical machines, and said he is nearly back to where he was before the stroke – even sawing down a tree recently.

“The fact that I am where I am is 100% the result of the stroke unit and the stroke team,” Parr said. “I will be thankful and grateful to them for the rest of my life. Everyone moved so quickly and knew what needed to be done.”