Health
New stroke treatment helps more Canadian patients return home to their normal lives
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The Current19:05Calls for greater access to life-saving treatment for stroke
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.
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.
Pregnant women urged to get whooping cough vaccine
Pregnant women in the Black Country are being urged to get vaccinated against whooping cough after a rise in cases.
The bacterial infection of the lungs spreads very easily and can cause serious problems, especially in babies and young children.
The Black Country Integrated Care Board (ICB) is advising pregnant women between 16 and 32 weeks to contact their GP to get the vaccine so their baby has protection from birth.
The UK Health Security Agency warned earlier this year of a steady decline in uptake of the vaccine in pregnant women and children.
Symptoms of the infection, also known as “100-day cough”, are similar to a cold, with a runny nose and sore throat.
Sally Roberts, chief nursing officer for the ICB, which covers Wolverhampton, Dudley, Walsall and Sandwell, said anyone could catch it, but it was more serious for young children and babies.
“Getting vaccinated while you’re pregnant is highly effective in protecting your baby from developing whooping cough in the first few weeks of their life – ideally from 16 weeks up to 32 weeks of pregnancy,” she said.
“If for any reason you miss having the vaccine, you can still have it up until you go into labour.”
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The number of measles cases has stabilized, according to the Montreal Public Health.
Since March 25, there have been no contaminations reported within the community.
“Our teams have identified all contact cases of measles,” said media relations advisor Geneviève Paradis. “It’s a laborious task: each measles case produces hundreds of contacts.”
All community transmission cases since February 2024 have been caused by returning travelers who were either unvaccinated or partially vaccinated.
Currently, there are 18 measles cases in Montreal – with 46 total in Quebec. This according to the April 18 figures from the provincial government.
“With the summer vacations approaching, if you’re travelling, it is essential to check if you are protected against measles,” explained Paradis.
According to Montreal Public Health, a person needs to have received two doses after the age of 12 months to be immunized against the virus.
They’ve launched a vaccination campaign throughout the region, and currently, 11,341 people have been vaccinated against measles in Montreal between March 19 and April 15.
Vaccination is also being provided in schools and at local service points.
“The vaccination operation is under the responsibility of the five CIUSSS of the territory,” concluded Paradis.
The World Health Organization has raised concerns about the spread of H5N1 bird flu, which has an “extraordinarily high” mortality rate in humans.
An outbreak that began in 2020 has led to the deaths or killing of tens of millions of poultry. Most recently, the spread of the virus within several mammal species, including in domestic cattle in the US, has increased the risk of spillover to humans, the WHO said.
“This remains I think an enormous concern,” the UN health agency’s chief scientist, Jeremy Farrar, told reporters in Geneva.
Cows and goats joined the list of species affected last month – a surprising development for experts because they were not thought susceptible to this type of influenza. US authorities reported this month that a person in Texas was recovering from bird flu after being exposed to dairy cattle, with 16 herds across six states infected apparently after exposure to wild birds.
The A(H5N1) variant has become “a global zoonotic animal pandemic”, Farrar said.
“The great concern of course is that in … infecting ducks and chickens and then increasingly mammals, that virus now evolves and develops the ability to infect humans and then critically the ability to go from human to human,” he added.
So far, there is no evidence that H5N1 is spreading between humans. But in the hundreds of cases where humans have been infected through contact with animals over the past 20 years, “the mortality rate is extraordinarily high”, Farrar said, because humans have no natural immunity to the virus.
From 2003 to 2024, 889 cases and 463 deaths caused by H5N1 have been reported worldwide from 23 countries, according to the WHO, putting the case fatality rate at 52%.
The recent US case of human infection after contact with an infected mammal highlights the increased risk. When “you come into the mammalian population, then you’re getting closer to humans”, Farrar said, warning that “this virus is just looking for new, novel hosts”.
Farrar called for increased monitoring, saying it was “very important understanding how many human infections are happening … because that’s where adaptation [of the virus] will happen”.
“It’s a tragic thing to say, but if I get infected with H5N1 and I die, that’s the end of it,” he said. “If I go around the community and I spread it to somebody else then you start the cycle.”
He said efforts were under way towards the development of vaccines and therapeutics for H5N1, and stressed the need to ensure that regional and national health authorities around the world had the capacity to diagnose the virus.
This was being done so that “if H5N1 did come across to humans, with human-to-human transmission”, the world would be “in a position to immediately respond”, Farrar said, calling for equitable access to vaccines, therapeutics and diagnostics.
Jeremy Hansen – The Canadian Encyclopedia
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