On July 28, 2022, Joel Pretz, a 52-year-old construction manager from Bay Ridge, Brooklyn, arrived home from a long, hot day at work feeling especially exhausted. He curled up on the floor with his 120-pound mastiff dog, Connor, and took a nap.
When Joel awoke, he sensed something was wrong. An avid bodybuilder, he found himself struggling just to stand up. His left arm was lifeless, as if he had fallen asleep on it. He did a push-up with his right arm and maneuvered to a nearby couch. Exhaustion hit him again.
“What is wrong with me?” he thought before falling asleep again.
Lisa Pretz had been trying without success to reach her husband by phone. When she arrived home and saw Joel, the air left her lungs. “The left side of his face looked like a melted candle,” she says. “I knew he was having a stroke.”
Joel was rushed by ambulance to the Emergency Department at NYU Langone Hospital—Brooklyn, in Sunset Park, where he was admitted at 8:13PM. Neurologist Brandon Giglio, MD, director of vascular neurology, and his team were waiting for Joel—standard protocol for the nearly 600 patients who arrive at the hospital for stroke care annually. NYU Langone Hospital—Brooklyn is one of only two in the borough certified by The Joint Commission, which accredits hospitals, as a Comprehensive Stroke Center for its capacity to provide the most advanced level of stroke care.
Joel had landed in the right place. Moreover, it had been less than six hours since the onset of his symptoms, which put him safely within the window for effective interventions. But his symptoms were severe. A CT scan showed blockages in the main arteries that supply blood to the right side of the brain. He had partial vision loss, slurred speech, and complete paralysis of his left arm and leg.
Joel also had a complicated medical history. He had been born with a congenital valve defect. In fact, he had had two open heart surgical procedures at NYU Langone Health under the care of renowned cardiothoracic surgeon Mathew R. Williams, MD, chief of adult cardiac surgery at NYU Langone Hospital—Brooklyn and director of the Heart Valve Center. Due to Joel’s medical history, he was ineligible for drugs routinely used in emergency departments to dissolve clots. So additional expertise would be required to remove the blockages.
The team called in interventional neuroradiologist Jeffrey Farkas, MD. He and Dr. Giglio agreed that Joel’s best treatment option was a thrombectomy, a minimally invasive procedure to remove brain clots in circumstances like Joel’s, where medication isn’t an option. With nearly 30 years of experience, Dr. Farkas is one of the pioneers in the use of minimally invasive procedures to treat stroke. The average Comprehensive Stroke Center performs 63 thrombectomies annually. At NYU Langone Hospital—Brooklyn, the team performed 95 in 2022.
“When it comes to stroke, restoring blood flow to the brain is the number one treatment,” says Dr. Farkas. “Joel’s blockages were at the top of his carotid artery. We had to get it open. It would be a pretty devastating injury if we couldn’t.”
By 9:00PM, 47 minutes after his arrival, Joel was in the interventional neuroradiology suite. Through a small incision in Joel’s groin, Dr. Farkas placed a long, flexible tube and advanced it to his carotid artery, which is the largest vessel supplying blood to the brain. Using real-time X-ray imaging for guidance, Dr. Farkas navigated a pair of devices to grab and extract two of the clots, which were in the carotid artery and just past it, in the middle cerebral artery. For the third clot in the anterior cerebral artery, which also leads from the carotid, he delivered a form of clot-busting medicine that Joel could safely receive. By 9:21PM the clots were gone, and Joel was transferred for recovery to the neurointensive care unit, part of the Center for Stroke and Neurovascular Diseases.
“National benchmarks state that we’re supposed to get stroke patients from the door to the start of thrombectomy within 90 minutes. With Joel, we got him there in half the time,” says Dr. Giglio. “Getting him there that fast is what saved his life and saved him from severe disability.”
When Lisa was able to see Joel, an hour after the procedure, he had regained full control of his arm and leg. “I almost fell on the floor, I was so shocked,” recalls Lisa. “When we got to the hospital, he had absolutely no movement in his left arm and leg, but after the procedure, he did it.”
The road from stroke to recovery is often long and arduous. Joel entered cardiac and stroke rehabilitation at Rusk Rehabilitation in Manhattan to be closer to his cardiac team. For six months, Joel worked diligently to regain his strength. Today, he’s healthy enough to take two-hour walks daily with his dog, and he has no neurological deficits. “The day of my stroke was an unforgettable day,” Joel says. “But I am so grateful—to my doctors, nurses, and therapists who helped me get my strength back, and of course, my wife.”
By the Numbers: Stroke Care at NYU Langone Hospital—Brooklyn
One of only two Comprehensive Stroke Centers in Brooklyn, NYU Langone Hospital—Brooklyn, distinguished by its team of neurologists, neurosurgeons, neuroradiologists, and specially trained nurses, provides rapid diagnosis and the most advanced treatment of stroke 24 hours a day, 7 days a week.
- Number of patients with stroke in 2022: 582
- Number of thrombectomies in 2022: 95 (other Comprehensive Stroke Centers perform 63 on average)
- Door-to-needle time: 29 minutes (New York City average: 42 minutes)
- Door-to-puncture time for thrombectomy: 55 minutes (New York City average: 82 minutes)