I have TIAs. TIA stands for Transient Ischemic Attack. And what, you may ask, is that? Let's just call a TIA a mini-stroke and leave it at that.
My attacks usually last less than five minutes and do not amount to much, at least not individually. Have enough TIAs and the damage is additive. I have suffered minor memory loss as a result of my numerous mini-strokes.
Having a TIA can be frightening, and rightly so. One particular attack, called an amaurosis fugax, leaves one or both eyes blind or partially blind for a number of minutes. Although there is usually no permanent brain damage, the blindness is temporary, such an event can be a precursor to a full-blown, life-altering, stroke. I've had close to a dozen of these dramatic, visual events.
TIAs and strokes are often caused by small blood clots, formed in the heart, traveling to the brain and lodging there. These block the blood flow to the brain. With TIAs the clot is unstable and quickly disintegrates. Blood flow is restored. With a brain-damaging stroke, the clot does not break-up and medical attention is needed quicky to prevent permanent brain damage.
Attempting to prevent the formation of these small blood clots is the usual response to frequent TIAs. This can mean taking an anti-coagulant for life. This, of course, comes with its own host of associated risks. Me, I take Pradaxa, one of the newer anti-coagulants. Many people rely on warfarin. That's right, the chemical used in rat poison.
Now, there is a new approach. It's surgical but minimally invasive. I learned about this new method of combating TIAs from one of my doctors at the London Health Sciences Centre.
Because I have micro-bleeding in the brain, I am not a great candidate for anti-coagulants. That's why I don't take warfarin, also known as Coumadin. Pradaxa is not as prone to causing a hemorrhagic stroke as warfarin. That said, there is an increased risk. Not good.
Why do some hearts generate clots and not others? Often the answer is atrial fibrillation or AFib. Some hearts, the ones producing clots, often have a quivering, irregular heartbeat. The blood tends to pool and swirl inside the heart before being pumped out to the body. This pooling and swirling in the heart encourages the formation of blood clots.
Some doctors now believe the clots coming from the heart are originating, for the most part, in a small sack on the left side of the heart known as the left atrial appendage (LAA). Blood gets into the small sack and remains there. Small but dangerous clots form in the trapped blood. These clots eventually leave the LAA to be pumped out of the heart and to the brain where they may cause a TIA or stroke.
If this theory is right, and there appears to be good reason to believe it is, then preventing blood from collecting in the LAA appears to be a possible answer.
Some cardiac surgeons are now plugging the LAA with a small closure device. There are a number of competing implants, among them is the Watchman from Boston Scientific Corporation.
This is what the FDA, U.S. Food and Drug Administration, has to say:
The Watchman LAA Closure Device is permanently implanted in the left atrial appendage (LAA) of the heart to prevent LAA blood clots from entering the bloodstream and potentially causing a stroke.
The cardiac-surgeon inserts the delivery catheter into the body through a vein in the leg. The catheter is threaded through the body until it reaches the right atrium of the heart. The physician makes a small hole through the wall between the two upper chambers of the heart (atrial septum) so the catheter can reach the LAA. The physician then pushes the device through the delivery catheter into the LAA where it opens up like an umbrella and is permanently implanted. Once in place, a thin layer of tissue grows over it in about 45 days.
The FDA notes that the device is used in patients who have atrial fibrillation, AFib, that is not related to heart valve disease.
Some time after the insertion of the device, a patient may be taken off the riskiest anti-coagulants as these are no longer necessary. Although, taking baby Aspirin, ASA in Canada, will likely be necessary for the rest of the patient's life. This is a far less risky drug than warfarin, Pradaxa, Xarelto and the other common anti-coagulants. And far less costly. My Pradaxa therapy is not cheap. Taking sophisticated drugs for life can be awfully expensive.
Will I have a Watchman or similar device inserted in my LAA? I don't know. The idea has been raised and my doctors are in consultation. I would not be surprised to have this exceedingly new solution to AFib used in my case. I am the first person in Canada to have a failed mitral valve repaired robotically using the da Vinci system, and I was one of the first patients to benefit from the use of the experimental T7 MRI unit at LHSC.
As I learn more, I'll repost or add to this post. Cheers!
Let me end with this final video. If you have AFib and are on, or considering blood thinners, you might find the following video interesting. Talk with you cardiologist.