The Calgary Stroke Program

The Calgary Stroke Program (CSP), a collaboration between the University of Calgary (DCNS and Hotchkiss Brain Institute) and Alberta Health Services (AHS), continues to lead and contribute to the field of stroke care. Our program figured prominently nationally and internationally on a number of fronts. We continue to strive to meet our vision of “Creating the Future of Stroke Care.”

The collective H-index of the clinician scientists within the program is 163, with over 127,000 citations and 1,122 publications cited at least 10 times.

Highlights/Key Publications

As the major CSP led publication of the year. Dr. Michael Hill, Mayank Goyal (PIs) and colleagues published the main results of the ESCAPE NA-1 trial entitled: Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial”. Lancet 2020;395:878-887.

An ongoing achievement of the program continues to be a leadership role in the HERMES Collaboration, led by Dr. Mayank Goyal. The collaboration successfully brought together all seven predominantly stent retriever based randomized clinical trials of mechanical thrombectomy in stroke (five published in NEJM 2015). This HERMES collaboration continues to roll out many publications—Lancet (1), JAMA (1), Lancet Neurology (3), JAMA Neurology (1), Stroke (7), Neurology (1) and JNIS (3)—that are influencing guidelines for EVT care throughout the world by clarifying when and how endovascular treatment is effective. Several of these manuscripts have been first or senior authored by CSP members, including Dr. Goyal, Dr. Michael Hill, Dr. Bijoy Menon and Dr. Mohammed Almekhlafi.

Clinical Trials

Dr. Coutts (PI) is leading the multicentre TEMPO-2 trial examining Tenecteplase (2nd generation tPA) for patients with mild stroke with a proven intracranial occlusion.  Sites are active in Canada, UK, Ireland, Austria, Spain, Brazil and Australia. 527 subjects have been enrolled.

Dr. Hill and Dr. Goyal (PIs) are now pushing forward to begin a second pivotal trial of the NA-1 neuroprotectant focused on patients undergoing endovascular treatment but ineligible for IV TPA.  The ESCAPE-NEXT trial Is collaboration between The Calgary Stroke Program and NoNO Inc (Toronto). This trial will enroll 1,100 subjects at over 50 sites in multiple countries. First enrolled patient expected by Nov 2020.

Dr. Menon, Dr. Hill, Dr. Goyal, Dr. Brian Buck and Dr. Rick Swartz have initiated the CIHR funded “Alteplase Compared to Tenecteplase in patients with Acute Ischemic Stroke: QuICR & OPTIMISE Registry based Pragmatic Randomized Controlled Trial”.  In only a few short months, 283 subjects have been enrolled across Canada at multiple centers with 2-3 patients now enrolled per day.

Dr. Demchuk (co-PI) will soon initiate recruitment locally of a phase 2/3 randomized trial of endovascular treatment in mild stroke entitled ENDOLOW in conjunction with co-PIs at Emory University (Atlanta), University of Cincinnati (Ohio) and Heidelberg University (Germany). This is a 200 patient study at 30 centres in four countries.  3 subjects are now enrolled with many sites coming on-line in the next few months Including Canada.

Dr. Almekhlafi and Dr. Goyal (PIs) have Initiated the CIHR funded “Evaluating oral peri-operative acetylsalicylic acid in patients undergoing endovascular coiling-only of unruptured brain aneurysms. A Phase 3 Multicenter Randomized Placebo-Controlled Trial”. Recruitment to the EVOLVE trial is soon to begin.

Dr. Phil Barber continues to lead the “Predementia Neuroimaging of Transient Ischemic Attack (TIA) – PREVENT Study”.

Team Grant/Core Lab Progress

Dr. Demchuk Is now winding down the “CaSTOR Canadian Stroke Trials for Optimized Results” national stroke clinical trials network funding by CIHR/ Institute of Circulatory and Respiratory Health. This $1.5 million emerging networks grant (2015-2020) is a collaboration with the Canadian Stroke Consortium and Canadian Partners for Stroke Recovery. A second global early career workshop is planned In December post WSC/ESOC 2020 to follow-up from the first one led by GAINS.

The Stroke Imaging Core Lab coordinates brain MRI and CT imaging for observational studies and clinical trials, with more than 15,000 brain scans analyzed. Imaging endpoints include strokes, hemorrhages, vascular occlusions, brain perfusion, and others. These endpoints are critical for understanding the natural history of stroke and the effectiveness of new treatments. The most significant accomplishment from the imaging core lab was the analysis of MRI imaging after non-cardiac surgery in participants in the NeuroVISION study published in the Lancet in August, showing that 7% of post-operative patients had a covert brain infarct and that those with covert brain infarcts had lower cognition than those without covert brain infarcts at one year. (NeuroVISION Investigators. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. Lancet. 2019;394:1022-1029. DOI 10.1016/S0140-6736(19)31795-7.)

The acute stroke imaging research program has expanded to now have research fellows from countries as diverse as The Netherlands, South Korea, UK, Switzerland, Saudi Arabia, Japan and China. The program has a full time imaging scientist, post docs and graduate students along with stroke fellows, neurology and radiology residents and summer students.

Personal Achievements/Appointments/Awards

Dr. Hill and Goyal were two of eight scientists at University of Calgary named as a “Web of Science highly cited researcher (top 1%) 2019.” Dr. Goyal was named the Heart and Stroke Foundation Chair in Stroke Research for a five year term.

Dr. Sean Dukelow received the honor of paper of the year at the Canadian Association of Physical Medicine and Rehabilitation entitled “Comparing CST Lesion Metrics as Biomarkers for Recovery of Motor and Proprioceptive Impairments After Stroke.”

Dr. Sean Dukelow and Dr. Demchuk continued as co-leads of the Leadership Council for Canadian Partnership for Stroke Recovery which replaces the role of Chief Scientific Officer with CPSR.

Dr. Andrew Demchuk was elected Chair of the Board of Directors of the Canadian Stroke Consortium in Nov 2019. HIs first act in this role was to gain approval amongst Its national membership that the CSC be the official professional organization for stroke physicians In Canada. He Is now in the process of transforming the organization to meet that prof org status as a value and designation based professional organization for Canada’s stroke docs.

On behalf of the Calgary Stroke Program, Dr. Hill, Goyal and Demchuk received the Scientific Breakthrough Award from the American Brain Foundation 2020.

Clinical Care Achievements

Initial planning of a new integrated stroke unit at Foothills Medical Centre has been completed. Architectural firm Group 2 and AHS (Nora Smith, lead) have led the planning sessions. A functional plan draft document has now been circulated describing the critical elements needed for a new unit and architectural renderings of how it might look. This is a critical step toward a future capital fundraising campaign and ultimate build of a new world-class integrated stroke unit.

Education

As of June this year, our program is training and/or has graduated 94 stroke fellows from 21 countries, including Canada.

Members

Stroke Neurology: Dr. Mohammed Almekhlafi, Dr. Simer Bal, Dr. Phil Barber, Dr. Philippe Couillard, Dr. Shelagh Coutts, Dr. Andrew Demchuk, Dr. Michael Hill, Dr. Adam Kirton (Pediatrics), Dr. Gary Klein, Dr. Bijoy Menon, Dr. Alekys Mineyko (Pediatrics), Dr. Steve Peters, Dr. Eric Smith, Dr. Peter Stys, Dr. Suresh Subramaniam, Dr. Julie Chrome

Stroke Physical Medicine and Rehabilitation: Dr. Sean Dukelow, Dr. Ken Lam, Dr. Gentson Leung, Dr. Steve McNeil

Physician Assistant: Allen Szabon

Vascular Neurosurgery: Dr. Alim Mitha, Dr. Garnette Sutherland, Dr. John Wong

Interventional Neuroradiology: Dr. Muneer Eesa, Dr. Mayank Goyal, Dr. Will Morrish

Nurse Practitioner: Nancy Newcommon

Stroke Program Manager: Samantha Arnott

Stroke Fellowship Program Administrator: Emily Collins

Stroke Observership/Sabbatical Program Administrator: Lori Herard