Neurovascular

Patient Population
Neurologists, neurosurgeons, neuroradiologists and allied health professionals participate in the Neurovascular Program at Toronto Western Hospital. Patient populations include those with stroke syndromes, vascular malformations of the brain and spinal cord and aneurysms of brain blood vessels. Within the Program, there are several components through which patients flow, depending on the type and acuity of the neurovascular disorder. These include the following:

Acute Stroke Program: Patients arriving within in the first few hours of an acute stroke are evaluated by the "Code Stroke" team. This group is available to provide emergency care with the latest "stroke busting" techniques. Advanced brain imaging facilities allow rapid and accurate diagnoses. Patients are admitted to the Acute Stroke Investigation Unit where they are cared for by a multi-disciplinary health care team. More than 300 patients were admitted to the multidisciplinary Stroke Investigation Unit for acute stroke management last year.

Stroke Prevention Clinic: Patients with TIA and stroke are referred to this ambulatory program for evaluation, expedient investigation and risk reduction. More than 800 patients were evaluated in the Stroke Prevention Clinic last year.

Arterial Venous Malformation and Aneurysm Clinics: Patients, referred from all over the continent, are assessed by a team of expert neurosurgeons, neuroradiologists and radiation specialists for evaluation of treatment options. More than 400 patients were seen in the new Aneurysm clinic in its first year

Interventional Neuroradiology Program: Tumour, AVM, aneurysm and stroke patients may be treated through this world-class Neurovascular Program component.

Education
Toronto Western Hospital has training programs in stroke for all health care professionals. Subspecialty electives are available for postgraduate medical trainees. Clinical and research fellowships are offered in stroke neurology, neuroradiology and neurosurgery. All nurses in the Acute Stroke Investigation Unit have has special training in stroke care.

Visiting physicians frequently come to learn new techniques in stroke care at TWH. Members of the Program have served as visiting professors around the world and many are members of professional journal editorial boards. An annual stroke course is presented by TWH members with the goal of educating generalists and specialists in the most up to date care of patients with neurovascular disease.

Research
Basic and clinical research in neurovascular disease is carried out by members of the Program. Several investigators are working to identify strategies for neuroprotection in acute stroke.

Since 1996 data on all patients with acute stroke seen at TWH has been kept in a computer registry to facilitate clinical research studies. TWH is responsible for the Canadian Stroke Registry, a computer database of stroke patients from across the country. These registries will allow a better understanding of the number, specific stroke types, and treatments for stroke.

Trials in which we have participated include: NASCET, the study that proved the value of carotid artery surgery for stroke prevention, and PROACT II the study that demonstrated the benefit of using a intraarterial thrombolysis in acute stroke. Ongoing evaluation of interventional neuroradiologic procedures is underway.