Saving Lives and Preventing Disability in Stroke

Interventional neuroradiologist Dr. Jai Shankar uses sophisticated x-ray imaging techniques to guide a catheter from an artery in the leg to a blood clot in a stroke patient’s brain, to extract the clot.
Stroke patients across Nova Scotia are gaining access to transformational advances in post-stroke care, thanks to clinical trials and health-systems research at NSHA. More people are surviving, with less disability, than experts could have dreamed possible just a few years ago. “We’re seeing the greatest advance since clot-busting thrombolysis came on the scene 20 years ago,” says senior stroke neurologist Dr. Stephen Phillips. 
 
This advance is a technique known as EVT—endovascular thrombectomy—in which an interventional radiologist threads a catheter into the patient’s brain through an artery in the leg. The catheter is equipped with a wire stent that becomes enmeshed with the clot so that it can be extracted from the blood vessel. 
 
“The results are astonishing,” says Dr. Jai Shankar, the interventional neuroradiologist who performed the first EVT in Nova Scotia on Christmas Day, 2011. “People were wary because it was a so-called experimental technique at the time, but when they see my videos of speechless and immobilized people sitting up and talking, minutes after the procedure, they are convinced.” Dr. Phillips and Dr. Shankar co-led NSHA’s participation in the ESCAPE trial, a Canadian-led international study comparing EVT plus thrombolysis (standard care) to thrombolysis alone. The results were published in The New England Journal of Medicine in 2015.
 
“Adding EVT to thrombolysis dramatically reduced disability and also cut the death rate by 50 per cent in the ESCAPE trial,” says Dr. Shankar. “So now EVT is the new standard of care.” The challenge is to make EVT accessible to all Nova Scotians, since the specialists and equipment required are located in Halifax and—given that two million brain cells die every minute after a brain-artery blockage—time is of the essence when it comes to stroke.
 
“We’re looking at practices and processes to determine how we can most efficiently identify eligible patients and get them to Halifax within five hours of symptom recognition,” explains stroke neurologist Dr. Gord Gubitz. 
 
Dr. Gubitz and Dr. Shankar are co-leading NSHA’s involvement in a new Canadian Institutes of Health Research (CIHR) - funded clinical trial of a neuroprotective agent that could protect stroke patients’ brains between the onset of symptoms and treatment in hospital. “Paramedics will administer the new drug on the way to hospital to help salvage the non-functioning parts of the brain before permanent damage occurs,” says Dr. Phillips. “If the drug proves successful in this situation, we will have yet another tool for improving outcomes in the face of rising stroke rates.”
 
This article was originally published in Research Focus: Neuroscience 2016