Ronald Cooper traveled from Sydney, Australia, to Buffalo for a lifesaving procedure.
But the hardest part of the nearly 10,000-mile journey was the few centimeters a doctor here navigated in his brain to open a fragile blocked artery.
Cooper in March suffered two small strokes from an almost complete blockage of his basilar artery, a key vessel for supplying blood to the brain.
The 78-year-old man was on medication but remained at significant risk for a fatal or paralyzing stroke. His doctors offered him little hope that anything more could be done medically to help him.
Angioplasty, in which a doctor threads a tiny catheter through a blocked blood vessel and expands a balloon to restore blood flow, is infrequently done in Australia for the condition.
So his daughter, Rhonda North, sprung into action, searching the Internet for physicians elsewhere who had successfully treated basilar artery narrowing with angioplasty.
She ran across published articles by physicians at the Gates Vascular Institute, emailed them about what options they might suggest, and they arranged for the family to come here. They completed a successful procedure for Cooper on May 12.
“This is the story of a daughter’s persistence to get the best care for her father,” said Dr. Adnan Siddiqui, professor and vice chairman of neurosurgery at the University at Buffalo and a neurosurgeon at Kaleida Health.
Cooper was overcome with emotion Tuesday as he talked about the journey to Buffalo and the life-saving procedure.
“I was always worrying about whether I was going to come back if I walked out of the house. Now, I feel I can walk out of here and be confident I will be walking for a few years,” he said, tears welling up in his eyes.
Cooper had been taking aspirin and Plavix, drugs prescribed to prevent blood clots from forming and causing strokes. But his doctors doubted the medications could effectively treat his blockage.
“He was basically told to prepare for his impending death,” said Siddiqui, who performed the procedure.
Siddiqui said it’s not a lack of skill in Australia that makes angioplasty a rarely performed procedure there, but a mindset across much of the medical community about procedures to resolve narrowing of arteries in the brain.
A recent study that compared stenting to medications for treating the condition in the brain found that aggressive medical therapy was better than trying to place a device in the artery to prop it open. Stenting increased the risk of complications, including stroke, in the trial.
That study greatly cooled interest among physicians in trying stents for conditions like Cooper’s.
But Siddiqui said the Gates Vascular Institute is among a small number of centers that have a successful track record with another procedure.
Rather than using a stent, he used a balloon not much bigger than a toothpick. He did this by inserting a catheter with the balloon at the tip through a tiny incision in Cooper’s groin and threaded it through blood vessels to the blockage in the basilar artery.
The artery only needs to be opened a bit – enough so that blood flow is restored and the vessel has an opportunity to fix itself.
“This is a simple procedure. We have been doing it for years, and our data shows angioplasty is far better than medical therapy,” Siddiqui said.
Currently, there is no independent study looking at angioplasty versus medical therapy for such conditions in the brain. But centers like the Gates Vascular Institute are publishing reports on successful cases like this one, and Siddiqui said it’s hoped that the work will reignite interest among device manufacturers or others in funding a trial.
He said the procedure is generally covered in the United States by private insurance for patients who have failed medical therapy, but not by Medicare, the federal health plan for the elderly, unless it is done as part of a study.
There was no health insurance coverage for Cooper, a retiree who formerly ran a company that made and sold office furniture.
“They cashed in their retirement funds to do this,” North said of her parents.
Cooper’s wife and two other children also made the trip, and were by his side as he described the care here.
“Everything was organized for us by the hospital. We came not knowing where we were going,” he said, cracking a joke about chicken wings. “There are very caring people in Buffalo.”
North said her dad’s condition led her to spend hours searching the Internet for information about treatments.
She came upon articles by Siddiqui and Dr. L. Nelson Hopkins, a SUNY distinguished professor and former chairman of the UB Department of Neurosurgery, who is considered a pioneer in the use of procedures to reopen arteries in the brain. He also is president of the Gates Vascular Institute.
“I would stay up until 1 a.m. five nights a week. I wanted to find the best people in the world,” North said.
She said subsequent conversations with Siddiqui helped the family decide on a course of action.
“We were frightened about coming. It was such a long journey,” she said. “But they gave us the confidence and courage to make the trip.”