At 6:44 p.m. on May 8, 2023, Frank Nyberg, MD, was nearing the end of his shift at Syosset Hospital when the call came: EMS was on the way with a stroke victim. More than 795,000 people in the U.S. have a stroke each year, and as an emergency medicine physician, Dr. Nyberg had cared for his share. But this wasn’t a typical stroke patient. This was an 18-year-old collegiate athlete with no history of serious health problems.

Adrian Mejia was a freshman at SUNY Old Westbury who had been recruited to serve as point guard for the Panthers, the school’s NCAA Division 3 basketball team. The season ended earlier that spring, but on that day in May, Mejia and his teammates were playing a pickup game outdoors. Mejia caught a pass and drove for a lay-up, but his momentum took him past the basket and into the pole supporting the hoop. He hit his forearm — hard.

“It hurt, but I didn’t think anything of it,” he recalls. “Then I started feeling a tingling sensation that started in my left hand and traveled up to my shoulder. A couple of minutes later, I felt tingling in my left foot, and it started traveling up my left leg.” But he wasn’t concerned until he missed the next shot.

“I started to get a headache and a little drowsy, like I needed to sit down,” says Mejia. “I asked a friend on the bleachers for some water because I was very thirsty. But he couldn’t understand what I was saying.”

When the ambulance arrived at Syosset Hospital, Dr. Nyberg immediately ordered an angiogram — an X-ray that would show how Mejia’s blood was flowing. The exam revealed a large clot in his internal carotid artery, one of the main vessels that feed the brain. Mejia was having a stroke.

When a stroke is caused by a clot, the protocol is clear: As long as it’s been less than 4.5 hours since the onset of symptoms, clinicians generally administer something called tenecteplase, an intense clot-busting medication. But there was a catch. Mejia had also suffered a physical trauma when he collided with the pole, and then again when he hit his head at the athletic center. It was unclear if those traumas dislodged a clot that already existed in Mejia’s body, but the fact that he might have hit his chest was concerning.

“If you have trauma to the chest and develop neurologic symptoms, you could have an aortic dissection” — a tear in the inner layer of the aorta, the artery that carries oxygen-rich blood from the heart to the rest of the body, says Dr. Nyberg. An aortic dissection can cause massive internal bleeding. “If that’s what happened, and we gave him tenecteplase, it would kill him,” Dr. Nyberg says.

But if they didn’t infuse the medication, the massive clot would continue blocking blood flow to Mejia’s brain. And that could also be fatal.

Dr. Jung and his colleagues inserted a catheter in the femoral artery in Mejia’s right groin and snaked it up to the right carotid artery in his neck. Then they used a suction device to pull out the clot. Even given Mejia’s precarious position, everything went smoothly. Within 15 minutes, the procedure was over.

Mejia woke up in a hospital bed at SSUH in a room full of people. His mother and younger brother had rushed to Long Island from their home in Washington Heights, as had several other family members and friends. “My uncle was the first person I spoke to,” says Mejia. “He told me that I had had a stroke.”

“The vibe in the room was just so sad. Everyone was in shock and confused about how this could happen. My mother and brother had trouble gathering themselves,” says Mejia, who tried to reassure them that he was OK.

Dave Rice — a family friend who Mejia says is like a father to him — was there as well. He was impressed by Mejia’s refusal to see himself as a victim.

“The next day, I was at the hospital with him, and he says, ‘Coach, I remember what you taught me. Things don’t happen to me; they happen for me,’” recalls Rice, who is co-founder of Kings of New York Athletics, an organization that helps young men and women get the opportunity to play collegiate sports. “I said, ‘You will recover from this, you will get out of this bed, you will get your health back and you will play college ball again. The operative word is will.”

Strokes most often occur in people 55 and older. When the problem occurs in someone younger, doctors typically order an echocardiogram to check for a condition called patent foramen ovale (PFO) — a hole between the two upper chambers of the heart. Sure enough, Mejia was among the 5% of stroke victims who have this congenital defect.  

“PFO is fairly common, and in many cases, it doesn’t cause symptoms. But its presence can sometimes lead to significant health risks,” says Chad Kliger, MD, director of structural heart disease of cardiovascular and thoracic surgery at Northwell’s Lenox Hill Hospital.

That’s because a PFO can allow a tiny blood clot to travel from the right side of the heart to the left side — and blood from the heart’s left side goes directly to the brain.

Mejia would need another procedure, this time to close the hole in his heart. On August 31, Dr. Kliger performed the procedure at Lenox Hill, avoiding traditional open-heart surgery.

“We use a minimally invasive approach and insert a small tube that enters the vein in the leg. With an ultrasound inside the heart, we can see the PFO clearly,” Dr. Kliger says. He placed a closure device into Mejia’s heart — two discs that sat on either side of the hole. “This device acts as a scaffold,” he says. “Tissue grows over it, effectively and permanently sealing the defect.”