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When Marleen Conacher was taken to a hospital for major stroke treatment for the second time in a week in 2021, she wasn’t treated with a clot-busting drug like she was previously given at North Battleford Hospital in Saskatchewan.

Instead, she was transported directly to Royal University Hospital in Saskatoon, where a stroke team performed an endovascular thrombectomy (EVT). 

The procedure involved passing small devices through one of the arteries in her groin, and then using suction, or tubes called stents to pull the stroke-causing blood clot out.

“I don’t recall when they, they put the little claw-like thing up through my groin and it went up through the artery and, and into my brain,” she said. “But I do remember feeling when they had got to it and were pulling it out.”

“It was a great deal of pressure. It did not hurt, but it was a great deal of pressure,” she told The Current‘s Matt Galloway.

Within a few days of the stroke, Conacher was out of the hospital, walking on her own and ready to go shopping. 

She said she doesn’t think about the stroke much these days.

“I don’t spend a lot of time, you know, thinking about having a stroke or whatever or that time,” she said. “I just thank the good Lord that I am here.”

EVT procedures are a relatively new option in the field of ischemic stroke treatment. In 2015, a study known as the escape stroke trial led by the University of Calgary’s Hotchkiss Brain Institute found that, overall, positive outcomes for stroke patients increased from 20 per cent to 55 per cent thanks to EVTs.

Today, EVTs are used in about 25 to 30 major hospitals across Canada — and according to the senior study author and stroke specialist Dr. Michael Hill, it’s had a “massive treatment effect.”

“People would come in and they were paralyzed on one side, they couldn’t speak or they were severely affected, and they were leaving the hospital in two or three days,” he told Galloway.

“That was a visible change … whereas [before] people would have stayed many days and weeks for their recovery and rehab, if they survived at all.”

Speed is critical

Hill said the key to this procedure’s success is speed, as “10 or 15 minutes makes a difference.”

That’s why a patient is often greeted at the door by a team of emergency department nurses, physicians and the stroke specialist.

“When we’re alerted to a stroke or suspected stroke syndrome and we’re meeting somebody in the emergency room, we’re hustling to get there and be there before the patient or just after the patient arrives,” said Hill, who is a neurologist at the Foothills Medical Centre in Calgary.

WATCH: Dr. Michael Mayich explains how clots that cause strokes can be removed

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Dr. Michael Mayich at the London Health Sciences Centre’s University Hospital explains how a new medical device from Vena Medical is used to remove clots in the brain that cause a stroke and reverse those symptoms.

From there, medical personnel conduct a clinical and imaging assessment to confirm if a patient has a blood clot and where it may be.

If the clot is in a location that is “amenable to a vascular treatment,” then an EVT will be offered.

Sedation can be approached in two ways, he said.

“Sometimes, patients are completely co-operative and we can do it completely awake. Sometimes they require some degree of sedation to keep them still.” 

“You can imagine it’s important to do this procedure with your head relatively still. You can’t have them thrashing around.”

A game-changer

Hill said EVTs have a lot of potential in improving stroke treatment, as positive outcomes are a lot more frequent.

“So it’s terrific, right? We get people back to their lives,” he said. 

In an ideal world, of course it’s available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?-Dr. Michael Hill, stroke physician

At the moment, EVTs aren’t available for all Canadians. Hill said the procedure is usually reserved for patients with the most severe forms of ischemic stroke, which occurs when the blood supply to part of the brain is interrupted or reduced.

“It’s a tertiary-level procedure. You’re not going to see it in a small, rural hospital,” he said.

But part of that has to do with the volume of cases needed in order to develop expertise in this field, and it’s big hospitals in major cities that tend to see the most patients.

“So if you’re just doing one a year, you’re more likely to have complications than you are to be successful,” he said. “Whereas if you’re doing 150 a year … everyone’s ready for these things to occur because you’re doing it so frequently.”

Still, it’s important to balance that expertise with availability.

“In an ideal world, of course [EVT is] available everywhere because you don’t have a stroke just because you live in the middle of Calgary or the middle of Toronto, right?” He said. 

For the time being, Conacher is content with how the procedure turned out — it’s been nearly two years and the only major impact the stroke has had is a bit of memory loss.

Furthermore, as someone who saw her dad suffer paralysis in his left side due to stroke, she’s pleased with the way stroke treatment is evolving.

“If they had things like this, I think he would have been just as fine as I was,” she said. 

Produced by Ines Colabrese.

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The gene variant is one of three that can affect the chances of a person developing Alzheimer’s disease.

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A new study led by Sunnybrook researchers has found that APOE ε2, a gene variant known to be protective against Alzheimer’s disease, is only protective in men and not women. The research was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association today.

“Previous research has shown that women have an increased risk of developing Alzheimer’s disease,” says Dr. Jennifer Rabin, senior author of the study and a scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute. “Although factors such as longer survival may contribute to why women are more likely to develop the disease, recent research suggests biological mechanisms may also impact sex differences in Alzheimer’s risk and progression.”

APOE ε2 is one of three inherited gene variants that can affect the chances of a person developing Alzheimer’s disease. Having the APOE ε2 variant decreases risk, whereas having the APOE ε4 variant increases risk. APOE ε3, the most common variant, is believed to have a neutral effect on the disease.

The collaborative study team, which included researchers from Canada and the United States, looked at whether sex modifies the association between the protective APOE ε2 gene variant and cognitive decline, using publicly available data from cognitively unimpaired adults that were part of four observational research sources.

The authors found that across two independent samples of participants, men with APOE ε2 were more protected against cognitive decline compared to women with the same APOE ε2 variant. In addition, men with APOE ε2 were more protected compared to men with the neutral gene variant (APOE ε3/ε3). However, this was not the case in women. In women, those with APOE ε2 were no more protected than those with the neutral gene variant (APOE ε3/ε3). The reasons for these sex-specific effects remain unclear. However, one possibility is that declining estrogen levels that occur with menopause may be a contributing factor given that estrogen has neuroprotective effects.

“These results suggest that the longstanding view that APOE ε2 provides protection against Alzheimer’s disease may require reevaluation,” says Madeline Wood, a graduate student at Sunnybrook and lead author of the study. “Our findings have important implications for developing sex-specific strategies to prevent and treat Alzheimer’s disease, particularly given that women are at a higher risk than men.”

The authors say the next step in their research is to continue to replicate the findings in large and diverse samples and to further investigate the sex-specific effects of APOE ε2 on Alzheimer’s disease biomarkers.

Funding for this study was supported by The Harquail Centre for Neuromodulation, the Dr. Sandra Black Centre for Brain Resilience & Recovery, Canadian Institutes of Health Research, and the Alzheimer’s Society of Canada.

Media Contact:
Samantha Sexton
Communications Manager, Sunnybrook Research Institute
Samantha.sexton@sunnybrook.ca

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Robin Millard (The Jakarta Post)

PREMIUM

Agence France-Presse/Geneva, Switzerland   ●  
Thu, March 30 2023

The World Health Organization said on Tuesday it is no longer recommending additional COVID-19 vaccine booster doses for regular, medium-risk adults as the benefit was marginal.

For such people who have received their primary vaccination course and one booster dose, there is no risk in having further jabs but the returns are slight, WHO’s vaccine experts said.

The United Nations health agency’s Strategic Advisory Group of Experts on Immunization (SAGE) issued updated recommendations after its regular biannual meeting.

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