Brain imaging following transient ischemic attack
The TIA study was the springboard for the research of Dr. Shelagh Coutts, who collaborated with Dr. Demchuk when she was completing her postdoctoral fellowship. Now on the faculty at the University of Calgary, Dr. Coutts is running her own trial—called CATCH—to compare the ability of MRI and CT angiography to predict who is likely to have a subsequent major stroke after a TIA. Patients who come into the Foothills Hospital with a TIA or minor stroke (within 24 hours of onset) are eligible to be enrolled in the trial. Participants receive specialized CT imaging and an MRI. After the images are analyzed, patients who are at low risk are sent home, and those at high risk receive treatment. All patients are followed for 90 days. The CATCH trial has already enrolled more than half of the target of 500 patients.
As far as the final results go, Dr. Coutts notes that CT angiography does not have to be as good as MRI to be useful. “Even if it is 90% as good as MRI, CT angiography will still be valuable because it is so widely available—most emergency departments have a CT scanner and can do the procedure. This means we could have a significant impact on preventing major strokes.”
Her research has convinced Dr. Coutts that TIA is an excellent opportunity for urgent stroke prevention, and she is leading another project aimed at improving care for people who have TIAs. Her team has implemented a TIA hotline for physicians across Alberta. When emergency physicians or family doctors see a patient who may be at high risk for a stroke, the hotline will connect them immediately—day or night—to a stroke specialist in Edmonton or Calgary. The specialist will help the physician to assess the suspected TIA accurately and to treat it quickly. “Our goal is to equalize stroke care between rural and urban Alberta,” explains Dr. Coutts. “Other provinces are following our lead and starting their own hotlines. There’s now more recognition that a TIA is a real emergency, not a disease to be leisurely referred to a neurologist.”
Calgary Stroke Program
The Calgary Stroke Program is recognized as one of the leading programs in North America for stroke treatment and research. It was the first service in Canada to provide access to the clot-busting drug tPA and is on the forefront of stroke prevention, acute treatment, imaging, and recovery. “Collaboration is key to our success,” says Dr. Andrew Demchuk, director of the Calgary Stroke Program. “We have a group of people who work cohesively together with a common goal of improving all aspects of stroke care.”
Dr. Demchuk says that the program benefits from its Calgary location because the size of population allows clinical work to be focused at one site: the Foothills Medical Centre. The hospital sees about five or six strokes and two or three TIAs every day. The patient volume means there is ample opportunity to do novel clinical research, which is a major attraction for residents (who are learning to be stroke neurologists) and clinical research fellows. The Calgary Stroke Program has trained several neurologists from India and other countries in the last few years. Clinical research fellows are critical to the success of research projects and clinical trials, as well as patient care. One faculty member and one fellow who are dedicated to stroke patients are always on call at Foothills. “This is a tough, tricky disease. Having people focused only on stroke is a good thing,” says Dr. Demchuk.
For more information on the Calgary Stroke Program, go to
http://www.calgaryhealthregion.ca/programs/stroke