CVMC and UVM Medical Center Anchor UVM Health Network’s Regional System of Life-Changing Stroke Care

Montpelier, VT – The Sunday morning in late January started off like any other for David Goodman and his wife, Ronda: coffee in the living room of their Montpelier home. 

But when Goodman, 70, got up to make breakfast, walking into the couple’s kitchen to retrieve a frying pan, things took a strange turn. As he reached down to pick up a pan from the cupboard, Goodman realized that he could not feel anything with his left hand. “What was that?” Goodman thought. 

“This kind of odd feeling was coming over me,” he said. 

Goodman, who has mild, persistent asthma which is controlled through an inhaler, went to get his medication. He opened the inhaler but, strangely, could not get it to work. He stumbled back, fell and landed safely on a chair – his wife calling out to ask if he was OK. Seconds later, she was at Goodman’s side, shocked to see one side of his face drooping noticeably and hear his speech slurred. 

Recognizing the warning signs of a stroke, Ronda called 911, setting off a chain of events that would end with Goodman returning home the very next day. A remarkable outcome for someone who had just suffered a stroke due to the complete blockage of a major artery supplying blood to his brain. Arterial blockages, known as a large vessel occlusion (LVO), account for 24% to 46% of ischemic strokes.  

Five minutes after Ronda picked up the phone, paramedics were taking Goodman via ambulance to University of Vermont Health Network – Central Vermont Medical Center (CVMC). There, members of the hospital’s Emergency Department (ED) care team ordered a CAT scan that quickly revealed a clot’s in a major artery in his brain. Goodman spoke via telemedicine with Fatemeh Sobhani Sweeney, MD, a vascular neurologist based at University of Vermont Medical Center, who prescribed the clot-busting medication that was administered in the ED at CVMC. 

Goodman doesn’t remember many specifics of the sequence of events, as emergency physicians, nurses and stroke care specialists rushed to prevent as many neurological impacts from the stroke as possible. 

“Time seemed to be going pretty quick at that point,” he said. 

In Goodman’s case, that was true in more ways than one, said Dr. Sobhani Sweeney. 

“Every minute, we lose about two million neurons,” she said. “In patients who have a large vessel occlusion, like David, the risk of more severe and permanent neurological disability – and even mortality – is even greater. A larger portion of the brain is at risk of dying.” 

‘Time is of the essence’ 

Clot-busting medication, called thrombolytic, which Goodman received at CVMC are central to many advances in stroke care over the last three decades. But as with so many other aspects of post-stroke treatment, time is of the essence. The medications are only effective for a brief window of time: a few hours after a stroke occurs. 

Patients with LVOs have more than just time working against them, said Dr. Sobhani Sweeney. Thrombolytics are only effective about 20 percent of the time at removing a clot like the one that caused Goodman’s stroke.  

As it became clear that Goodman would need endovascular intervention to remove the clot and reestablish a major source of blood flow to his brain, the stroke care teams at CVMC and University of Vermont Medical Center continued to race against the clock. 

By the time Goodman arrived at UVM Medical Center, about 45 minutes after leaving CVMC via ambulance, the neurological impacts he was experiencing had become even more pronounced. 

“When there’s a blockage your brain tries to compensate, using other arteries and connections to deliver blood to help the part of the brain that is suffering,” said Dr. Sobhani Sweeney. “But there’s only a certain amount of time that it can compensate. Time is of the essence.” 

A regional system of exemplary stroke care

When CVMC earned Primary Stroke Center (PSC) designation in 2024, the hospital joined UVM Medical Center as the second hospital in Vermont certified for exemplary stroke care. The years-long effort was a priority because of the region’s demographics and the hospital’s desire to serve as a regional resource for patients, hospitals and emergency responders, said Ryan Clouser, DO, FCCM, chief medical officer at CVMC. 

“CVMC serves one of the oldest populations in Vermont, and our state has one of the oldest populations in the country. Most of the hospitals closest to us are Critical Access Hospitals, and when someone presents to them with acute, stroke-like symptoms, they’re getting transferred,” said Dr. Clouser. “It’s about creating the stroke system of care for every patient and being a part of global stroke strategy in Vermont.” 

PSCs play a lead role in university of Vermont Health Network’s efforts to expand and improve stroke care throughout Vermont and northern New York. Telemedicine, like the virtual assessment Goodman underwent at CVMC, helps patients access potentially life-changing thrombolytics therapies they otherwise would not be able to, said Dr. Sobhani Sweeney. 

“There’s a lot of data that these systems of care increase the chance of effective treatment and result in better outcomes for patients,” she said. “The goal is to provide specialty care for hospitals that otherwise wouldn’t have access.” 

‘It was like nothing ever happened’ 

With Goodman’s neurological condition deteriorating, stroke specialists at UVM Medical Center moved quickly to surgically remove the blood clot that was denying vital blood flow to his brain. Dr. Sobhani Sweeney assessed Goodman and explained the procedure that would restore blood flow to his brain through the blocked artery. 

Using minimally-invasive technology and techniques, a neuro-interventional radiologist inserted a catheter into the artery in Goodman’s leg, using the blood vessel to access and remove the clot from his brain. Goodman, who was under general anesthesia for the procedure, only remembers waking up and feeling back to normal. 

“I felt fine, like nothing really happened,” he said. “It was like nothing ever happened.” 

Goodman spent the rest of the day and that night on UVM Medical Center’s intensive care unit, receiving hourly checkups by the hospital’s neurology team. The following morning, he underwent a series of physical and neurological exams, as well as evaluations of his cognitive and physical abilities. 

A follow up MRI found no neurological damage – though Goodman did experience headaches and bouts of nausea for a couple of weeks following his ordeal. 

 About 34 hours after his left hand first went numb, Goodman was back at home with his wife and looking forward to a globe-spanning trip to Australia, to visit his son and his partner. 

Speaking about his ordeal in April, after returning from Adelaide, Australia, where he swam in the Indian Ocean, played disc golf with his son and explored the region as summer turned to fall, Goodman couldn’t help but wonder about the cause of his stroke – and why he had been so fortunate. 

“How was I so lucky, to walk away basically unscathed?” he said. “I think everything happening at the right time, and my wife having the presence of mind and knowledge to call 911.” 

Dr. Sobhani Sweeney agreed – but added that Goodman’s willingness to follow the recommendations of his care team were a factor as well.  

“These treatments do change patient outcomes, but this case is pretty amazing,” said Dr. Sobhani Sweeney. “Patients often end up being in the hospital for a longer period of time, even after receiving these life-altering treatments.”