Innovative Multidisciplinary Neurosciences and Cardiology Team Save Oklahoma Man’s Life
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From the demands of law enforcement to the challenges of working on oilfield pipelines, 57-year-old Todd Sheets of Bridge Creek, Oklahoma, has lived an active life. But in April 2012, his health took a turn for the worse and the recovery proved to be anything but simple. Todd had a narrowing of his basilar artery, which meant that his brain was not getting the blood flow it needed. This medical crisis marked the beginning of a decade-long struggle and a departure from the active life he once led.
Located at the base of the brain, the basilar artery plays a critical role in supplying oxygen-rich blood to various brain regions and the nervous system. When this vital artery becomes blocked, it disrupts blood flow to the brain.
A blockage or rupture to the basilar artery can cause a stroke, with a mortality rate exceeding 90% if left untreated. Common symptoms include:
- Weakness on one or both sides of the body
- Dizziness or vertigo
- Headache
- Speech problems
- Tremors in the arms and legs
- Facial weakness
- Hearing loss
- Difficulty swallowing
- Inability to move one or both sides of the face
Todd’s doctor provided him with what is known as the “best medical therapy,” a collection of evidence-based interventions aimed at reducing the risk of cardiovascular disease, cerebrovascular and coronary mortality, and morbidity. His regimen included aspirin, an additional blood-thinning medication, cholesterol-lowering drugs, and diligent diabetes management. He worked hard to take care of himself, but the basilar artery blockage grew worse.
Following a basilar artery stroke, Todd could barely speak or walk, and he was being fed by his mother through a feeding tube. It was only a matter of time before he had another stroke, possibly a fatal one, but the only treatment available to Todd wasn’t working.
From Desperation to Hope
Todd had undergone 19 surgeries over the course of a decade and endured very poor health — he was in a constant fog, drooling, nauseated, falling over, passing out, unable to drive, couldn’t remember things, couldn’t think straight, and was constantly experiencing vertigo and dizziness.
Desperate for a second opinion and a lifeline, Todd went to see OU Health neurosurgeon Dr. Hakeem Shakir, M.D., assistant professor in the Department of Neurosurgery at the University of Oklahoma College of Medicine.
Dr. Shakir performed an angiogram, a procedure that uses X-rays to check for blockages in the blood vessels. The angiogram revealed that Todd’s basilar artery was now completely blocked. Todd’s brain was receiving blood from the circle of Willis — a ring of blood vessels at the base of the brain that connects the main arteries. If a brain artery becomes blocked, the circle of Willis can sometimes compensate. In Todd’s case, his blood flow was reduced.
As the best medical therapy for Todd’s condition wasn’t helping, Dr. Shakir had to find another way to treat Todd.
Planning the Procedure
“There was no textbook on how to manage Todd’s condition beyond what had already been done,” explains Dr. Shakir. “If Todd was to survive, we had to find a way to open that basilar artery back up.”
Dr. Shakir partnered with OU Health interventional cardiologist, Dr. Mohit Pahuja, M.D., assistant professor in the Section of Cardiovascular Diseases in the Department of Internal Medicine at the University of Oklahoma College of Medicine to devise a plan that would save Todd’s life.
When a person has a blocked coronary artery, a surgeon may insert a stent into the blocked artery. A stent is a small mesh tube designed to keep an artery open and facilitate normal blood flow. Stents are also used for heart attacks, aneurysms, or angina. They are not normally used to treat blockages in the brain, but Drs. Shakir and Pahuja knew that it was Todd’s only option.
“Placing the stent in the basilar artery is not something that is commonly done. It was a last resort,” said Dr. Shakir.
The stenting procedure is generally performed in the coronary space for revascularization of hearts and recanalization of a vessel. Drs. Pahuja and Shakir painstakingly created a plan and found exactly the right sized stent they would need, and using the same principles as coronary stents, applied it to the artery in Todd’s brain.
The procedure carried a high risk, and Todd was warned that his condition could worsen or potentially lead to death. Todd knew that without the procedure, he would continue to regress until he died. It was a risk that Todd knew he had to take.
“The arteries in the brain work differently than those in the heart,” explained Dr. Shakir. “It was a heightened sense of anxiety as it’s an off-label use of a heart stent being used in the brain. We could not predict what would happen, but Mr. Sheets had no other options. We didn’t go in blindly and have it randomly work out — this was carefully planned and executed.”
Cautious Optimism
Under the care of Drs. Shakir and Pahuja, and the expert OU Health multidisciplinary team, the procedure was performed on August 23, 2023.
The endovascular procedure – a minimally invasive procedure done through the blood vessels – took two hours. Dr. Shakir used a long, thin tube to access Todd’s arteries rather than cutting into his skull. The stent was fed through the radial artery via a small puncture site in Todd’s wrist. Dr. Shakir and team could see on the angiogram that once the stent was correctly positioned in the basilar artery, the blood started to flow normally. However, the full effects of the procedure wouldn’t be known until Todd woke up from the anesthesia.
“We were cautiously optimistic,” said Dr. Shakir. “But as the patient was anesthetized, we had no way of knowing how he would respond until he woke up.”
Once Todd woke up, he could immediately sense that he didn’t feel as foggy as usual. Over time, with the blood flowing normally and reaching all the parts of his brain, Todd made dramatic strides. The dizziness and vertigo which affected his balance and equilibrium resolved, allowing him to walk. Todd was able to speak, eat, and within months, he was able to drive again.
How to Improve Basilar Artery and Brain Health
Simple lifestyle changes can keep your brain and basilar artery healthy and reduce your risk of having a stroke.
- Maintain a healthy body weight
- Control your blood pressure
- Lower your cholesterol
- Eat a balanced and nutritious diet
- Exercise regularly including strength training and aerobic exercises
- Quit smoking and do not use any tobacco products
- Manage chronic diseases and illnesses such as diabetes and heart disease
See your physician for help in managing chronic diseases and improving your overall health.
A Second Chance
Now, Todd’s life is entirely different. The procedure is a permanent fix to the basilar artery blockage, and providing Todd maintains a healthy lifestyle by being careful with his diet and keeping his blood pressure under control, it has also reduced his stroke risk.
“It’s been a long road for the last 10 years,” Todd said. He is grateful that because of this innovative procedure he has another chance at life. Dr. Shakir is delighted with the result and enjoys being able to give hope to people who otherwise have none.
