- [Announcer] "Your Fantastic Mind," brought to you in part by Sarah and Jim Kennedy.

(dramatic electronic music) (dramatic electronic music continues) - Welcome to "Your Fantastic Mind," I'm Jaye Watson.

Every 40 seconds, someone in the United States has a stroke, a brain attack.

Every three minutes and 14 seconds, someone dies of a stroke.

Now the vast majority of strokes, 87%, are ischemic, meaning blood supply to part of the brain is blocked or reduced.

The other type of stroke, suffered by 3.4 million people each year, is the deadliest.

A hemorrhagic stroke is when a weakened blood vessel ruptures and bleeds into the brain.

Now, in many ways, this devastating stroke has been hopeless, until now.

Physician scientists at Emory University have come up with a groundbreaking game changer set to revolutionize the field, saving countless lives on a global scale.

(soft ethereal music) Watching a soccer game at his children's school, Perry LeBlanc had no idea of his luck.

He didn't feel lucky, as the worst headache of his life hit.

- If I could just get a couple of Advil and a Coke, I'll be fine.

- [Jaye] LeBlanc went to the bathroom, but did not come out.

- Called my son and I said, "Can you go in the bathroom and see if daddy's okay?

'Cause he's not coming out and I'm waiting."

And he came out and said.

She couldn't get him to open the stall and we needed to get help.

So the security people broke into the stall and brought him out and put him in the ambulance.

(siren blaring) (tense music) - [Jaye] The first hospital quickly transferred him when they saw he had a bleed in his brain, a hemorrhagic stroke.

- They then took me to Emory, and that's where by God's grace, Dr. Pradilla was, with this procedure.

And you know, as I told him the first time I met him, he was the hands of God that not only saved my life, but gave me the quality of life we have.

- It's all a blur, but I do remember a doctor coming in in the morning and saying he does some type of trial, and would I be willing to try.

- [Jaye] This surgery that Cheryl Leblanc said yes to saved her husband's life.

It was from a trial named ENRICH, Early miNimally-Invasive Removal of IntraCerebral Hemorrhage.

(soft music) Before ENRICH began at Emory in 2017, options for hemorrhagic stroke were limited, and the best treatment option was unknown.

The surgical procedure studied in the ENRICH trial did for Perry LeBlanc what researchers have been trying to do for decades, it safely evacuated the blood from his brain and he recovered and went back to work, back to his life.

Hemorrhagic stroke statistics show how remarkable that is.

It is the deadliest of strokes.

51 to 65% of people die within the first year, many within the first few days.

Six months after a hemorrhagic stroke, only 20% of patients are expected to be independent.

- That's the clot in the brain.

- [Jaye] Head of Emory Neurosurgery and co-principal investigator of the ENRICH Trial, neurosurgeon Dan Barrow.

- The type of stroke that we're dealing with with the ENRICH study is a spontaneous hemorrhage into the brain that's not from an aneurysm or a blood vessel malformation.

It's when it happens spontaneously.

And the underlying cause of that is not entirely understood.

But the most common condition that predisposes people to this is chronic hypertension, chronic high blood pressure.

The high blood pressure over time damages small, little, penetrating vessels that provide blood deep into the brain and weakens them, if you will.

- [Jaye] Many studies attempted to use surgical interventions for hemorrhagic stroke, but none of them were shown to be more effective than best medical therapy, which involves stabilizing patients with medicine and close monitoring and taking more of a watch and see approach.

Surgery is often a lifesaving last resort.

- If you think about it, somebody's got a blood clot in their brain.

Intuitively that seems like it ought to be a surgical disorder.

If you've got a blood clot in your brain, it's gotta be good to take it out, right?

Well, it turns out that in medicine, what intuitively seems to be the right thing to do isn't always the right thing to do.

(surgeon scrubbing intensely) - So in 1986, I was 10 years old and I remember I got a call from my mom that my grandfather was sick.

- [Jaye] Gustavo Pradilla's grandfather died from a hemorrhagic stroke at the age of 67.

He would learn this from his father, who was a neurologist.

- Intracerebral hemorrhage remained that one disease that was untreatable and not responsive to surgical care.

So that was something that I felt I needed to at least try to fix.

- [Jaye] He got his chance to do for others what could not be done for his grandfather.

Today, Gustavo Pradilla is an Emory and Grady Health system neurosurgeon.

- He's had a lot of those in the last- - [Jaye] And the co-principal investigator of the ENRICH trial, which was a multicenter, randomized adaptive trial that included 36 other sites around the country, including Mayo Clinic and Johns Hopkins.

- The study's primary goal was to compare a rate of function or disability between patients who had surgery and patients who were managed without surgery, medically treated.

Fast forward to a project called the Human Connectome.

- [Jaye] A lot has changed in our understanding of the brain in the past 15 years, and the Human Connectome Project is a significant part of that understanding.

It tackled an epic scientific challenge to map the human brain and to connect its structure to function and behavior.

- A project that used very powerful magnets to map the connections between different parts of the brain.

That allows us to learn all of these connections between the different lobes in the brain.

- [Jaye] The project has given birth to a new field of study called Connectomics and it is profoundly important in neurosurgery.

- So now we have identified these different networks, the network that generates speech, the network that generates logical thinking, the network that processes our calculations when we're doing a math problem.

All of those networks are now being very granularly identified.

- [Jaye] Knowing this, the old way of surgery for hemorrhagic strokes no longer made sense.

- That's something that we did not know when the first studies were done.

So when a surgeon was picking a trajectory, they were usually going for the closest to the surface, the shortest distance to the lesion.

And in the path to the clot, many of those connections between lobes were damaged and many of these networks became disconnected.

(dramatic music) - I got a phone call from a woman who used to actually work in our operating room that knew me and this is her son.

- [Jaye] And on a night in January, we were there when a 49-year-old man from Milledgeville Georgia, two hours from Atlanta, was flown to Emory after having a hemorrhagic stroke.

- He was the perfect candidate for the procedure.

The right age, the right volume, the right location, the right time in presentation.

So we're hoping he has a very good outcome for this.

- [Jaye] Three days before his 50th birthday, neurosurgeons will attempt to remove the blood from inside Jeff Newton's brain with minimally invasive parafascicular surgery, MIPS for short.

(monitor beeping) - What we're doing is preparing to identify the best trajectory to get into the blood clot to avoid any injury to the brain.

- [Jaye] Instead of removing a large part of his skull to access the blood clot as in the past, this is the new way, - This is the incision.

So this is where we're gonna go in, right there.

(drill whirs) Rather than doing this through a large opening like we used to in the old days, we'd open the scalp and take a big piece of bone off and go through the brain to get to it.

What we now do is use a very small incision, drill a very small hole about the size of a quarter.

So this is the piece of bone we removed.

And we'll put this back in place, it's a dead piece of bone, but it's his dead bone and by putting it back in place, it'll serve as a scaffolding into which new bone will grow.

So it'll heal very much like a broken bone would heal.

- [Jaye] Through the hole, this blue tube with a pointy nose.

- [Dan] You can see covering of the brain as we open.

- [Jaye] The brain path device will be inserted.

- The brain path device is a port that enters the brain through one of the natural creases in the brain that we call the sulci.

So instead of having to cut the brain, the cortex of the brain, which is this procedure we call a corticectomy, we just open over one of the natural openings that are on the surface and the device enters and it's designed to split the fibers and push them out of the way instead of transecting them.

We are able to couple that brain path device to our CT and MRI images and we're able to triangulate the position of that, like your car gets the GPS to take you home.

It triangulates, it creates a start point and a target and it's that trajectory that we picked is based on these connectomic data.

- So these are 3D glasses, everything magnified and under very bright illumination.

We're looking at the clot now under magnification using what's called an exoscope.

It's a scope that's like a microscope, but rather than looking through it, it is viewing the field and we're looking at a console, very much like you would be playing a computer game.

(soft music) - [Jaye] The brain path device makes its way to the blood clot.

- As soon as we put the trocar in, blood just spontaneously came out because it was under such pressure.

And that's one of the benefits of this technique, is it just gets you right inside the clot and the pressure is immediately released to normalize it, to prevent secondary injury to the brain.

- [Jaye] The third device is the myriad.

It removes the blood from the brain, which now clotted, can be the consistency of jelly or rubber.

- [Dan] We used a device called the myriad device, which is a device that mechanically breaks up the clot and suctions it up.

- If you use a conventional suctioning device, it will not do the job or it will get clogged many, many times over and you have to stop the surgery, clear the suction, try again and go through that many, many dozens of times during the surgery.

- [Jaye] The myriad removes the clot bit by bit, revealing the surrounding brain tissue.

- So this is a portion of the blood clot that was removed.

Obviously it was quite large, but this is one of the chunks of blood that was in the brain that we removed.

So far so good, everything went very well.

Hi.

- Hey.

- Hi!

- All the news is good news.

Everything went well, we're finished.

We're just moving him off the table to a gurney that'll bring him back to the intensive care unit.

- The blood vessel that was the source of it was completely clotted off.

We didn't see anything arterial and we got a very thorough evacuation.

We didn't see any blood left.

- Now the work starts, people that have this condition are at high risk of pneumonias, deep vein thrombosis.

That's why he's gonna be in this intensive care unit with these incredible neurointensivists and critical care nurses who deal with this all the time.

It's so nice to be able to say, we know what the best option for him is.

A year ago we would've said, we have two options and we honestly don't know what is going to be best for your loved one.

And now we know, so that's very comforting for us.

- Thank God for the trial he did last year.

It was just perfect that he, everything fell right into place and it is so appreciated.

Yeah, really appreciated.

- All right, guys.

- Have a good night.

- Thank you, thank you, guys.

(family chattering) - Oh, that's okay.

- Good morning.

- Hey, doc.

- How are you?

- Still here.

- You look good.

Hold both of your arms out in front of you with your palms to the ceiling, like you're catching raindrops.

Close your eyes, leave them both right there.

Try not to let them move.

Now touch the tip of your nose with that finger.

Good for you.

Where your hemorrhage was is a part of the brain that controls the vision in the left half of your left eye and the left half of your right eye, what you see over there.

I mean, he looks terrific.

He's certainly more awake and alert than he was before.

And it looks like his only neurological deficit is some loss of peripheral vision off to the left, which would be expected based upon where his hemorrhage is.

Well, we're here if you need anything.

- Appreciate you.

- Alrighty.

- [Jaye] After Dr. Barrow visits Newton.

- I think they're gonna be bringing in the team too to talk to you.

- [Jaye] The morning rounds begin.

- A right occipital bleed, for which he was then transferred here to Emory.

- This is a particularly bad place in the brain to have a hemorrhage, by tomorrow or the next day- - [Jaye] Dr. Owen Samuels is the director of Emory's Neurocritical care unit.

- But let's just take a look at pre and post, right?

So pre and post is pretty impressive.

- [Jaye] Samuels and his team examine Newton's dramatic before and after brain scans.

- On the left side, this is the pre-OP scan, and this is kind of now you see it and then you don't.

The hemorrhage is virtually gone.

Let's go say hi to him.

Good morning.

Would you mind taking off your glasses for a minute so I can take a look at your vision?

You survived the night, and hopefully a new lease on life as well.

Tell me when you see my finger one.

- Yeah, it's still there.

- [Owen] Tell me when you see my finger.

Tell me when it stops.

- That's it.

- From the hemorrhage data out there, most of the morbidity and mortality, meaning the overall long-term injury is from ICU related complications.

'Cause patients who have brain issues, they're certainly acute, potentially catastrophic brain issues.

Even with surgery that quote unquote works, the recovery is still prolonged and the longer it is, the more risk you are for complications.

You had a hemorrhage on the right side of the brain in the back.

- [Jaye] Dr. Samuels has treated thousands of hemorrhagic stroke patients.

- If he hadn't gotten here, there would be a good chance that not only was his hemorrhage expanded, but he would've led to brain herniation and death.

So of the ones who survive, probably the majority of them, you know, have significant disability and some have really severe, severe disability.

And your mom, I'm sorry, your mom.

- [Jaye] Because of ENRICH, Dr. Samuels and his team do something they weren't able to do before, visit Newton, who was doing well.

- All right, I'll see you later.

- [Jaye] And move on to the next patient.

- I mean, this is a pivotal trial that is field changing.

I mean, it really is, it's a goosebump kind of moment in a disease that really had, it had no treatment.

- It's just, it's hard being on this side of the OR.

- [Jaye] Jeff's mom, Virginia St. John, worked at Emory for 35 years, many of those years in the OR with the neurosurgeons.

- I always wanted to know what the prognosis was when I was in the OR.

You know, I know what you're doing here in surgery, but what's it gonna be like for them when they leave?

- [Jaye] She took Jeff to the ER in Milledgeville after he complained of a headache and earache.

- So then he says, "It hurts right here."

And I went, "Hmm."

So she says, well, and then they took his blood pressure.

His blood pressure was 178 over 110.

I was like, my eyes went, oh.

And so immediately I thought stroke.

- [Jaye] The medical team did a CT scan.

- Comes back in the room and she said, "He has a brain bleed, and it's significant."

I knew enough that I thought it was over.

Right then, I thought he was gone.

I didn't think he would make it here to Emory.

My father, his mother, and seven siblings died of a left temporal aneurysm.

And I just knew he was, I thought he was dead.

(sobs) (somber music) - [Jaye] St. John called Dr. Barrow.

- [Virginia] He said, "We'll take care of him."

He says, "We've got this."

He told me, he said, he goes, "If I get outta this, there's a lot of changes I have to make."

Now, just seeing him sitting up in that chair in there, getting a new chance at life.

- [Jaye] Jeff Newton is honest about what that chance will require of him.

- Change.

Living life a little differently, trying to take care of myself more.

Quit smoking, and a drinker.

I'm gonna work on that and see if we can make some changes to be around for my kids.

- [Jaye] Over the next week in the Neurocritical Care unit.

- [Doctor] Hey there.

How are you doing?

- [Jaye] Newton is monitored 24/7.

He receives multiple MRI scans of his brain, is taking anti-seizure and pain medication, along with wearing a nicotine patch.

- You are gonna probably be more tired.

- [Jaye] And he's counseled on his continuing recovery at home by neurointensivist Dr. Casey Albin.

- So making sure you're getting plenty of rest, checking the blood pressure.

The blood pressure medications are really important to stay on.

- I know he won't be lifting or anything soon, but would he in a month maybe be able to return to that?

- Yeah, I would anticipate no shorter than a month.

All right, let's get you home so you can actually rest.

(monitor beeping) - [Jaye] This five year trial of 300 patients at 37 centers required a unified approach.

Surgery was within 24 hours and was standardized.

Teams use the same technology and tools.

The findings of ENRICH are now published in the New England Journal of Medicine.

ENRICH is the first study ever to show that surgery for intracerebral hemorrhage is beneficial by saving lives and improving neurological function.

Surgery decreases the length of hospital stay and ICU stay.

Surgery patients experience far fewer complications and adverse effects.

And surgery decreases the cost of care for the hospital and for the healthcare system as a whole.

It is extremely rare to have a medical treatment that hits these three points.

Safer, better, cheaper.

ENRICH did it.

- I think the most exciting part of it is that we open the door to new concepts and new technologies that are gonna go beyond removing block clots for intercerebral hemorrhage.

These are technologies that will go into brain tumor treatment, that will go into treatment of traumatic brain injury and the whole gamut of things that will be based on a lot of the findings that we have was revolutionary.

- [Jaye] The real life success is Perry LeBlanc, restored to full health.

- [Gustavo So what we are looking at here is a front view of your brain.

- [Jaye] Sitting down with the surgeon who saved his life five years ago.

- [Gustavo] We see this very large round bright area here.

That was the blood clot.

- [Jaye] It's the married father of 6-year-old twin girls whose life was saved days before he turned 50, who received what was not available to all the thousands before him.

- Well, I should have been dead.

- [Jaye] Another chance.

- [Jeff] I'll crawl, and then I'll walk.

It's gonna be a fact.

- Another chance is what millions will receive in this new enriched era.

The urgency of ENRICH is critical.

The latest hemorrhagic stroke data is from 2019 and considering the rapidly expanding global population, projections indicate that a staggering 5 million people will face hemorrhagic strokes in 2024 alone.

On a positive note, access to the necessary surgical interventions is increasing.

Most leading academic medical centers already possess the technology and expertise, with community hospitals expected to follow suit in the coming years.

That's going to do it for us this week.

See you next time on "Your Fantastic Mind."

(dramatic electronic music) - [Announcer] "Your Fantastic Mind," brought to you in part by Sarah and Jim Kennedy.