Stroke and Cerebrovascular

Stroke and Cerebrovascular

The Vancouver Stroke Program is based at Vancouver General Hospital, the quaternary care stroke centre of excellence for the province of BC. In addition to providing the highest standards of clinical care, the stroke program is involved in delivering excellence in cerebrovascular research and education.

Clinical Care

The Vancouver Stroke Program is dedicated to providing the highest standards of care in the management of acute stroke, inpatient post-stroke management, secondary prevention, and post-stroke issues. The VGH Stroke Service is staffed by neurologists with expertise in stroke who are available 24/7, 365 days a year via the VGH Stroke Pager to immediately evaluate patients suffering from a possible acute stroke and to answer advice calls from physicians around the province. Interventional therapy for eligible hyperacute stroke patients is available 24/7/365.

Stroke neurologists provide urgent consultations when they are on service and also manage the inpatient stroke unit.

Outpatients are assessed Monday-Friday in the VGH Stroke Prevention Clinic, which serves as a critical resource for emergency departments and physicians across the Lower Mainland needing rapid expert assessment for patients with stroke. TIA- or other cerebrovascular concerns. In addition to rapid urgent outpatient assessments, the Stroke Prevention Clinic has subspecialty interdisciplinary cerebrovascular clinics, including the only adult Moya-Moya disease clinic in Canada.

Education

Education ensures that physicians are familiar with the rapidly-advancing improvements in stroke care. We have an intensive weekly educational program aimed at trainees, physicians, and allied health professionals, including didactic noon rounds on Tuesday, clinical noon rounds on Wednesdays, and a weekly academic seminar and journal club for stroke fellows.

Our clinical-research stroke fellowship trains future stroke specialists from Canada and around the world. Medical students, UBC and elective residents and fellows rotate on the VGH Stroke Service and attend the VGH Stroke Prevention Clinic.

Members of our group lead the neurology education committee for the UBC Faculty of Medicine undergraduate program and examine for the Royal College of Physicians and Surgeons of Canada. Our stroke neurologists are also actively involved in public education and national and international best practice initiatives including spokesperson roles for Heart and Stroke campaigns, and best practice guideline committee participation.

Recent best practice guidelines by our group members:

http://www.strokebestpractices.ca/prevention-of-stroke/

http://guidelines.hypertension.ca/prevention-treatment/

Research

Research helps to drive improvements in clinical care. The Vancouver Stroke Program maintains an active profile in investigator-initiated research and has a long history as a recruiting site for clinical trials in acute stroke and secondary prevention. Our research is regularly published and presented at international conferences and our investigators hold peer-reviewed PI funding CIHR and the Heart and Stroke Foundation of Canada. From 2009 until 2013, the NIH-NINDS funded Secondary Prevention of Small Subcortical Strokes (SPS3), a multicenter international trial was coordinated from UBC. To date, over 50 peer-reviewed publications have been produced from the SPS3 database.

Recent high-impact studies including participation from the Vancouver Stroke Program:

DATAS II – Dabigatran Following Transient Ischemic Attack and Minor Stroke (DATAS II)
https://journals.sagepub.com/doi/10.1177/1747493017711947
https://clinicaltrials.gov/ct2/show/NCT02295826

EMBRACE – 30-Day Cardiac Event Monitor Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE)
https://www.nejm.org/doi/full/10.1056/NEJMoa1311376
https://clinicaltrials.gov/ct2/show/NCT00846924

ESCAPE-NA1 – Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1)
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30258-0/fulltext
https://clinicaltrials.gov/ct2/show/NCT02930018

NASPAF-ICH – NOACs for Stroke Prevention in Patients With Atrial Fibrillation and Previous ICH (NASPAF-ICH)
https://clinicaltrials.gov/ct2/show/NCT02998905

NAVIGATE ESUS – Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention of Systemic Embolism in Patients With Recent Embolic Stroke of Undetermined Source (ESUS) (NAVIGATE ESUS)
https://www.nejm.org/doi/full/10.1056/NEJMoa1802686
https://clinicaltrials.gov/ct2/show/NCT02313909

POINT – Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial (POINT)
https://www.nejm.org/doi/full/10.1056/NEJMoa1800410
https://clinicaltrials.gov/ct2/show/NCT00991029

RESPECT – Patent Foramen Ovale Closure or Medical Therapy After Stroke – RESPECT Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1610057
https://clinicaltrials.gov/ct2/show/NCT00465270

REDUCE – GORE® Septal Occluder Device for Patent Foramen Ovale (PFO) Closure in Stroke Patients (REDUCE)
https://www.nejm.org/doi/full/10.1056/NEJMoa1707404
https://clinicaltrials.gov/ct2/show/NCT00738894

SOCRATES – [SOCRATES -Acute Stroke Or Transient IsChaemic Attack TReated With Aspirin or Ticagrelor and Patient OutcomES] (SOCRATES)
https://www.nejm.org/doi/full/10.1056/NEJMoa1603060
https://clinicaltrials.gov/ct2/show/NCT01994720

SPS3 – Secondary Prevention of Small Subcortical Strokes Trial (SPS3)
https://www.nejm.org/doi/full/10.1056/nejmoa1204133
https://clinicaltrials.gov/ct2/show/NCT00059306

Y-ESUS – Young ESUS Patient Registry (Y-ESUS)
https://pubmed.ncbi.nlm.nih.gov/34134793/
https://clinicaltrials.gov/ct2/show/NCT03185520

Our physicians

Oscar Benavente MD FRCPC

Thalia Field MD FRCPC MHSc

Kimia Ghavami MD FRCPC

Johnathon Gorman MD FRCPC

Sharanpal Mann MD FRCPC MHSc

Philip Teal MD FRCPC

Dominic Tse BHB MBCHB FRACP

Stephen Van Gaal MD FRCPC

Laura Wilson MD FRCPC

Samuel Yip MD FRCPC PhD

Lily Zhou MD FRCPC