More patients can now benefit from local stroke expertise

EDMONTON — More Albertans have a better chance to survive a stroke without serious disability thanks to minimally invasive, clot-clearing technology and expertise at the University of Alberta Hospital (UAH).

About 15 per cent of strokes are caused by a blood clot in the brain that can be cleared through a procedure called endovascular thrombectomy. During the procedure, a neuro-radiologist inserts a thin tube through an artery in the patient’s groin, guiding it with X-ray imaging through blood vessels to the brain to remove a clot using a retrievable stent. The procedure must be performed in a neurovascular interventional suite.

The current Canadian guidelines recommend endovascular stroke treatment within six hours of a patient’s first symptoms of stroke; however, new evidence suggests the likelihood of serious disability may be reduced even if the procedure is performed up to 24 hours after the first symptoms of stroke in a small group of patients.

“The current timelines to give clot-busting drugs or access minimally-invasive therapy limit the options we can use to treat those having a stroke,” says interventional neuro-radiologist Dr. Jeremy Rempel. “Based on new research, extending the time patients can access endovascular treatment at our site could be a game-changer for stroke patients across western and northern Canada who receive care at UAH.”

The hospital is home to the only two neurovascular interventional suites in the northern half of the province. The first suite, originally built in 2005 with support from the University Hospital Foundation, received a $1.7 million equipment upgrade in December 2016, fully funded by donor support through the foundation’s Brain Centre Campaign.

The suite is outfitted with biplane angiography that enables the treatment of stroke and other neurological conditions, including brain aneurysms, hemorrhages within the skull, brain and neck tumours, and blockages of the arteries that supply the head and neck with oxygenated blood.

About 90 endovascular thrombectomies were performed last year at UAH — a number that has the potential to increase to more than 100 per year given the new research and the new neurovascular interventional suite. Patients living in remote areas who require more travel time to receive treatment in Edmonton will be one of the groups to benefit most.

Bruce Nelson of Darwell, located 90 km west of Edmonton, was transported to UAH last year after he started slurring his speech during a visit to his family doctor. After collaborating with the UAH stroke team, Dr. Rempel performed an endovascular thrombectomy, removing a two-centimetre clot.

Nelson, 70, spent five days in the UAH stroke unit, walking and talking normally upon discharge.

“Dr. Rempel told me patients with my type of stroke normally require long-term, assisted living care for the rest of their life,” says Nelson. “I’m so grateful I received the care I needed as quickly as I did, and they had the right team with the right equipment available in Edmonton.”

Previously, if a patient presented in a rural/remote community with stroke symptoms at the six-hour mark, options for treatment may have been limited to taking an Aspirin and referring the patient for rehabilitation.

“Community support has played a leading role in giving doctors at the UAH the equipment they need to save the lives of more stroke patients,” says Jim Brown, Cabinet Co-Chair of the University Hospital Foundation’s Brain Centre Campaign.

AHS President and CEO Dr. Verna Yiu says in all cases of stroke, the patient’s best chance of recovery is to get treatment as soon as possible.

“Having two neurovascular interventional suites at the University of Alberta Hospital will make an enormous difference in the quality of life for stroke patients, especially for Albertans who may have missed out on treatment due to time constraints.”

Adds Dr. Rempel: “We don’t want to give the impression that we can now relax and take our time. Stroke is still a condition that kills millions of neurons every minute. We have simply proven that some people can still benefit from this technology much beyond what we originally thought. But time is still of the essence and we have to move as fast as possible to treat these patients. That’s why having two suites is so critical, so no patient will have to wait for treatment.”

The University Hospital Foundation raises and manages funds to advance patient care, research and healthcare education at the University of Alberta Hospital, the Mazankowski Alberta Heart Institute and the Kaye Edmonton Clinic.

The foundation’s Brain Centre Campaign has raised $50 million to transform brain care since 2011. Funds have been invested in upgrading patient care spaces; putting the most advanced technology in the hands of the brain care experts at the University of Alberta Hospital; and supporting research that is changing the future for brain patients.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

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