“We had built a reputation by the mid-’70s as being the “stroke” hospital,” Dr. Black says.
In the 1990s, there was a renewed interest in the importance of stroke units, with research coming from Europe showing patients in a stroke unit experienced shorter lengths of stay, reduced mortality and better outcomes in a year. Support of Sunnybrook’s unit continued to grow, and last year Sunnybrook opened a new 16-bed unit providing rehab team care seven days a week. This means stroke rehabilitation can begin on Day 1, with the aim of maximizing recovery.
Sunnybrook was also one of the first in Canada to be authorized to use tPA as a treatment for patients.
“With tPA, Sunnybrook’s stroke research started being glamorous because we could sometimes reverse a stroke and cure people,” Dr. Black says. “The tPA trials and funding by the Heart & Stroke Foundation became a catalyst for improving the system for care in the province.” Sunnybrook’s work on stroke was instrumental in the creation of the Ontario Stroke Network, an organization that oversees the province’s regional stroke centres and strives to improve care and recovery across Ontario.
Sunnybrook’s stroke scientists also began to make it possible for those living in remote communities to benefit from tPA. In the late 1990s and early 2000s, with funding from the Canadian Stroke Network, Sunnybrook and Toronto’s University Health Network led the development of the innovative Ontario Telestroke service, which allows neurologists to consult with ER physicians in communities across Ontario via videocameras to assist in the delivery of tPA.
“I think Telestroke is a jewel in the crown of the Ontario Stroke System,” says Dr. Black, noting the service provides tPA treatment to almost as many patients in all smaller cities combined as the bigger regional stroke centres, 50 to 70 a year.
More recently, Sunnybrook has developed a rapid response clinic aimed at diagnosing and treating “mini-strokes” before they become major episodes. The Dr. Thomas and Harriet Black High-Risk TIA Unit consists of a team of specialists that provides fast-track care to those who have had a transient ischemic attack and who are at imminent risk of suffering a major stroke. Patients are able to quickly receive diagnostic tests and treatment to reduce the risk of a major stroke by up to 80 per cent.
IN THE SPOTLIGHT
Sunnybrook continues to make important breakthroughs in stroke research, says Dr. David Gladstone, director of Sunnybrook’s Regional Stroke Prevention Clinic.
Last year, Drs. Gladstone, Richard Aviv and colleagues launched SPOTLIGHT, a multicentre clinical trial of a new image-guided treatment protocol for the deadliest form of stroke, intracerebral hemorrhage. The study aims to help patients with bleeding in the brain. Eligible patients are randomly assigned to receive the drug recombinant activated Factor VII, which has shown promise to stop bleeding.
“There currently is no proven treatment to stop bleeding in the brain. The hope is that this treatment approach, if administered quickly enough and to the right patients, will save lives and reduce disability,” Dr. Gladstone says.
The trial came about based on observations during the daily workload at Sunnybrook. Neuroradiologist Dr. Aviv developed the “spot sign” method which predicts which patients are actively bleeding and at highest risk of getting worse due to the bleed expanding. Meanwhile, Drs. Black and Richard Swartz also focus on the cognitive effects of stroke and stroke recovery, increasingly relevant to Canada’s aging population, about 25 per cent of whom have evidence of small, silent strokes that increase their risk of dementia.