Jan 23, 2022

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A 72-year-old man who suffered from atrial fibrillation and a transient stroke has become the first person in Israel to undergo a groundbreaking procedure to prevent a recurrent stroke. All efforts to reduce the risk of stroke, including blood thinners and cervical stenosis surgery, have not been effective. The patient suffering from recurrent events reached the gates of justice with a new incident of a clot being thrown into the left eye and endangering his vision.

The treatment was performed at Jerusalem’s Shaare Zedek Medical Center. An advanced spring-like Javelin implant was inserted into the carotid artery in his neck to prevent blood clots from advancing toward his brain.

A transient ischemic attack (TIA) known commonly as a “ministroke” is a stroke that lasts only a few minutes. But nevertheless, it is not a minor incident; it can become very serious. A TIA occurs when the blood supply to part of the brain is briefly blocked. The sudden symptoms of a TIA are like other stroke symptoms, but do not last as long. They include numbness or weakness, especially on one side of the body in the face, an arm or leg; slurred or garbled speech or difficulty understanding others; or blindness in one or both eyes or double vision.

The main difference between a stroke, which is also when there is a blockage of blood flow to the brain, and a TIA is that the symptoms of a TIA almost usually resolve themselves within a short period of time – a few hours to a whole day.

Since ministroke and stroke symptoms are nearly identical, it is best to seek emergency medical attention if you experience any of them.

Blood clots are the leading cause of TIAs. When there’s a clot in an artery that’s connected to the brain, blood can’t flow as freely as it needs to, which means the brain doesn’t get the oxygen it needs to work properly.  In a ministroke, these clots are usually temporary and are reabsorbed quickly, restoring proper blood flow.

Occasionally, fatty material in the artery (plaque) or an air bubble can cause a ministroke. Rarely, a small amount of bleeding in the brain (hemorrhage) can cause a ministroke. The risk of blood clots goes up with age, since the older one gets, the narrower the blood vessels become.

Other factors that can increase the likelihood of experiencing a blood clot include high blood pressure (hypertension); narrowed arteries caused by plaque buildup (atherosclerosis) in or around the brain; smoking; diabetes; high cholesterol; and obesity.. 

Cardiologists at the hospital’s Heart Center, which is integrated with the stroke unit, inserted an advanced implant that will prevent blood clots from reaching the brain in patients at maximum risk after atrial fibrillation. The first transplant in the country was successfully led by Dr. Danny Dvir, director of the Interventional Cardiology Unit and Catheterization Rooms, thanks to his many years of experience in performing minimally invasive procedures.

All efforts to reduce the risk of stroke, including blood thinners and surgery, had not been effective. The patient had a blood in the left eye that endangered his vision.

Dr. Roni Eichel, director of Shaare Zedek’s stroke center and Dvir recommended to the patient that he undergo the innovative treatment, which prevents blood clots from reaching the brain and thus prevent a recurrent stroke that could endanger the patient’s life or cause severe disability. 

The implant is designed to stop emboli (clots) from anywhere in the body and not just from the heart. The transplant is done by direct injection into an artery under ultrasound, without anesthesia or sedation and lasts only a few minutes. The unique implant is produced by Javelin Medical, an Israeli start-up company located in Yokneam in northern Israel founded by Dr. Ofer Yodfat and Dr. Guy Shinar.

“We inserted the implant into each of the two carotid arteries in the neck,” said Dvir. “The patient was sent home on the day of the transplant, and we are very pleased with the results of this first -ever procedure in Israel.”

 “If a patient arrives quickly after the symptoms appear, we have many ways to help. f he arrives late he may be left with lifelong damage and even worse, die,” explained Eichel. “We wanted to find ways to prevent a stroke, because once a stroke occurs, the likelihood that we can help depends on the patient’s arrival time. This is one of the technologies that can help us prevent cases of recurrent strokes, from which the survival rate without long-term damage is very low. The innovative implant will help complex patients who – despite all the advanced treatments – still return with blood clots being introduced into the carotid artery towards the brain. The new treatment is a perfect protection for them from death or severe disability. The procedure is currently being performed in aresearch setting under close clinical supervision and close monitoring even after the transplant, the results are encouraging.”