Jack Smith cherishes classic cars and enjoys restoring them. Parked in his garage is a handsome 1935 Buick Model 50 Victoria Coupe. It is elegant with whitewall tires, curvaceous fenders and an Art Deco hood that showcases a gleaming “flying goddess.”

Smith is not the type to keep a classic beauty hidden. On a sunny Colorado day, he backs the refined automobile down his steep driveway. The modified Buick has a three-speed automatic transmission, power steering and brakes, and a big block 455 engine to power it all. After all that Smith recently went through, he operates it with seamless motion — and a smile.

His hands are steady on the wheel as he reverses down the driveway. You would never have imagined that earlier this year, Smith suffered a stroke involving a large blood clot in a major artery of his brain.

If not for a new procedure now offered locally that completely removed the clot, leaving Smith with no deficits, he might never have driven or worked on his classics again.

Why you never ignore the signs of a stroke: Time is brain

On a Saturday morning in April 2024, Smith woke with numbness in his left arm. He’d figured he’d slept on it wrong and attempted to get out of bed. Instead, he landed face down on the floor.

His wife, Shirley, was heading to the kitchen when she saw her husband roll onto the floor. His oxygen tube, which he needed for chronic obstructive pulmonary disease, or COPD, often fell off at night. Shirley assumed he was looking for it and figured his lack of gracefulness was due to being sore from yard work the day before.

Moments later, Shirley returned to the bedroom with coffee.  “He didn’t look right,” Shirley recalled. Her husband was sitting in a chair, but his left arm was limp along his side, and the left side of his face was droopy.

She immediately recognized the signs of a stroke and called 911.

Early identification of a stroke is the first step to a good outcome

EMS arrived within minutes. Trained to recognize a stroke, they quickly alerted UCHealth Poudre Valley Hospital that Smith was en route.

Research shows that 1.9 million brain cells die every minute someone is having a stroke.

“That means you are aging 3.1 weeks every minute (of a stroke), and if that transforms to hours, every hour, you could be aging by 3.6 years,” said Dr. Gautam Sachdeva, a vascular and interventional neurologist at UCHealth Medical Center of the Rockies in Loveland. “You have to save those (brain cells) in a timely manner to avoid irreversible deficits.”

UCHealth recently trained local EMS on how to recognize a specific type of stroke: a large vessel occlusion (LVO), which is a blockage in a major artery in the brain.

These “large strokes” increase a patient’s risk of death by more than four times and reduce the chances of a good recovery by three times, according to one study. However, by identifying an LVO early, a stroke team can prepare for a thrombectomy, the mechanical removal of a blood clot from a blood vessel. This procedure can potentially reverse devastating effects of a stroke by completely removing the clot to restore blood flow to the brain.

Why is the availability of thrombectomy important to northern Colorado and surrounding areas?

The first line of defense for an ischemic stroke, a clot in the brain’s vessels, is clot-busting IV medications. However, these drugs are only an option if delivered within the first 4.5 hours after the first stroke symptoms appear, and they don’t always work on large clots.

This presents treatment barriers, Sachdeva said. For example, Smith went to bed at 10 p.m., which was his last known time of “normalcy.” When he arrived at the hospital that morning, he was far beyond the treatment window for clot-busting medications.

A thrombectomy, however, can be done up to 24 hours after a patient last functioned normally. That  procedure is now  available at UCHealth Medical Center of the Rockies, centrally located in northern Colorado.

Medical Center of the Rockies is the first hospital between Denver and Casper, Wyoming, to offer this advanced procedure. In the past, Smith would have been transported in a helicopter or airplane to Denver for a thrombectomy, which could have delayed his care.

“Launching this program in northern Colorado is a significant development for our community because if a patient is experiencing a major stroke here, we can take care of it right away, and the patient will have a much higher chance of excellent recovery,” Sachdeva said.

Smith reached Poudre Valley Hospital at 9:46 a.m., and staff quickly conducted imaging, followed by interpretation to create a treatment plan. Smith was then flown by helicopter to Medical Center of the Rockies, arriving at 11:03 a.m. Sachdeva removed the large clot in the right side of Smith’s brain by 11:42 a.m.

“I can remember when we left on the helicopter, as I heard the pilot say we were approaching (MCR),” Smith said. “The next thing I knew, I was on a table, and all these people were asking me questions – can you feel this or that? That was after the surgery, and everyone was saying, ‘This is amazing.'”

The surgery: How a thrombectomy works.

Smith’s scans showed a large clot blocking blood flow almost entirely to the right side of his brain, but there was still “a large amount of salvageable brain tissue,” Sachdeva said. After quick approval from Shirley, Sachdeva started a thrombectomy on her husband.

Using a thin, flexible tube, also known as a catheter, Sachdeva followed an artery from the groin to the large clot in Smith’s brain. Assisted by X-ray guidance, Sachdeva used a special device inserted through the catheter to engage the clot and pull it out.

“He had full blood flow in a matter of minutes,” Sachdeva said. From “open to close,” the procedure took 14 minutes — one of Sachdeva’s fastest times.

And it was that quickness — from Shirley’s quick 911 call, emergency responders’ rapid determination of an LVO, medical staff’s efforts to get Smith on the operating table swiftly, and Sachdeva’s expertise—that had everyone amazed when Smith woke after his thrombectomy.

A fantastic recovery after a thrombectomy

Because the clot was in the right side of Smith’s brain, the left side of his body was affected, including his dominant left hand. After Smith woke from anesthesia, doctors performed a neuro exam to help determine the level of damage of the stroke. The exam is done every 15 minutes for the first two hours, every 30 minutes for the next six hours, then every hour for the next 16 hours, for a total of 24-hour testing. A patient’s responses are numerically valued – the bigger the number, the more rehabilitation a patient will likely need.

“Even in that first hour, we could see results. Jack was already moving his left side,” Sachdeva said. “By the next day, his score was zero. He had completely recovered in a day!”

Finding the cause of a stroke

In the United States, someone suffers a stroke every 40 seconds, and 80% of these strokes are preventable, according to the Stroke Awareness Foundation. Stroke survivors are more likely to have another stroke, so finding the cause of the stroke is important.

Luckily for Smith, while being monitored at the hospital, he went into atrial fibrillation, or AFib. According to the National Institutes of Health (NIH), AFib is estimated to cause 25% of strokes in older adults.

AFib is a heart arrhythmia in which the heart’s upper chambers beat irregularly, often much faster than normal. This increases a person’s risk for an ischemic stroke by three to five times because blood isn’t moving properly and can pool. That pooling can cause clots to form and travel to the brain.

AFib can be treated with long-term use of blood thinners that help to reduce the risk of a stroke by one-half to two-thirds, according to the NIH. In some cases, surgeons can manage a person’s AFib with specific procedures.

After the stroke, doctors placed Smith on blood thinners, and he would have been discharged if it wasn’t for another discovery: cancer.

How Smith’s stroke led to an early cancer diagnosis and treatment

When Shirley relayed to medical staff that her husband had fallen to the floor that morning before the ambulance’s arrival, they conducted an abdominal CT scan in addition to the brain scan to ensure there was no internal bleeding from the fall.

That is when physicians identified a mass in Smith’s bladder. Two days after the thrombectomy, Smith was back in surgery to have the cancerous mass removed.

After about six weeks of recovering from surgery at home, Smith started a weekly outpatient regimen of chemotherapy for another six weeks. A second scan this past fall showed no sign of cancer, and soon after, Smith celebrated his 79th birthday.

He’s back to working on his Buick. And on those lovely Colorado days, he’s cruising around town, listening to the quiet rumble of a classic, thankful he doesn’t have to leave it hidden in the garage.