A patient arrived at the Emergency department of Community Hospital of the Monterey Peninsula with classic stroke symptoms: paralysis on one side of their body and difficulty speaking. A CT scan pinpointed the trouble spot — a blood clot that had lodged in one of the arteries in their head, cutting off the flow of blood and oxygen to their brain.
Until recently, the patient might have been transferred to a Bay Area medical center to remove the clot, with each passing minute killing 1.9 million brain cells. But on this day, a clot-removing procedure called mechanical thrombectomy was newly available at Community Hospital.
A team led by neurosurgeon Dr. Tyler Cole quickly assembled in one of the hospital’s hybrid operating rooms and, in 34 minutes, removed the clot. Quick action and expert response led to an ideal outcome, with the patient having minimal lasting impacts from the stroke.
What’s a thrombectomy?
A thrombectomy is a minimally invasive stroke treatment used to remove a blood clot that’s blocking an artery in the brain. A thin, flexible tube called a catheter is inserted in the blood vessel through a small incision and guided to the brain. This allows the doctor to retrieve the clot, restoring blood flow and significantly reducing the risk of long-term brain damage.
This advanced, specialized procedure is part of Montage Health’s growing neurosurgery program in collaboration with University of California, San Francisco (UCSF), made possible by a significant philanthropic gift from David and Joan O’Reilly through Montage Health Foundation.
Previously, 40–50 patients per year were transferred out of Monterey County for neurosurgical procedures that are now available at Community Hospital thanks to the new UCSF partnership.
It’s really priceless to have these services available locally. With the high-level care that Dr. Cole and others provide, this is a game-changer for stroke care and other neurosurgical procedures in Monterey County.
— Daniel Covel, neuroscience program manager at Montage Health
Neurosurgery in Monterey County
Montage Health’s neurosurgery program offers a growing range of procedures, many of which are minimally invasive, meaning smaller incisions, less pain and scarring, faster recovery, shorter hospital stays, less time under anesthesia, and reduced risk of complications. In addition to stroke thrombectomies, procedures include:
Brain aneurysm coiling and flow diversion
Coiling prevents blood vessels in the brain from tearing due to aneurysms, which are balloon-like bulges near weak points in artery walls. When an aneurysm tears and bleeds, it can cause significant damage to the brain. Coiling fills the aneurysm with tiny coils to prevent it from rupturing. For aneurysms where coiling is not sufficient, flow diversion places a stent (small mesh tube) in the blood vessel to divert blood and prevent rupture.
Middle meningeal artery (MMA) embolization
MMA embolization is a procedure that blocks blood vessels to stop blood from accumulating between the brain and skull. This blood accumulation, called chronic subdural hematoma, often develops after head trauma and is very common in the elderly population. MMA embolization has shown remarkable success in resolving chronic subdural hematomas without the need for surgery to drain the hematoma.
Angioplasty and stenting
Angioplasty and stenting opens blocked or narrowed blood vessels in the neck and brain to improve circulation and prevent strokes. During angioplasty, a balloon is inserted into the blocked artery through a catheter and inflated to widen the blood vessel. A stent is then inserted to stabilize the balloon and prevent the blood vessel from narrowing again.
High-quality, local neurosurgery
“It’s a privilege to offer this service locally, preventing costly and time-consuming transfers to the Bay Area,” Cole says. "Here in Monterey, we're able to remove blood clots in the brain to restore blood flow, as well as secure bleeding sources in the brain, allowing patients to have a better chance at brain recovery and returning to their regular life.”
Dr. Steven Cabrales, vice president and chief medical officer of Montage Health, says the new neurosurgery program is elevating the entire organization.
“The advances we’re making and our expanded knowledge base elevate every aspect of care throughout Montage Health,” he says, “from the operating room to the Intensive Care Unit and beyond. With UCSF’s partnership, we’re building a world-class neurosurgery program right here at home.”
Learn more about neurosurgery at Montage Health.
