Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy may improve clinical outcomes in patients with large vessel occlusion (LVO) stroke possibly due to improvement in microvascular reperfusion.

We conducted a meta-analysis of randomized controlled trials (RCTs) evaluating IA thrombolysis with tenecteplase, alteplase or urokinase in anterior or posterior circulation LVO stroke after successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Efficacy outcomes were excellent functional outcome (modified Rankin Scale [mRS] 0–1), functional independence (mRS 0–2) and recovery without any disability (mRS 0) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (ICH), any ICH and death. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using random-effects models.

Seven RCTs (n = 2,130; 2022–2025) were included. IA thrombolytic drugs used were alteplase, tenecteplase and urokinase with doses ranging from 10 % to 50% of recommended IV dosage. IA thrombolysis significantly improved excellent functional outcome (mRS 0–1: OR 1.45, 95% CI 1.19–1.76) and recovery without any disability (mRS 0: OR 1.34, 95% CI 1.09–1.64), without safety risks (symptomatic ICH: 5.05% with IA thrombolytics vs. 4.49% in standard). Paradoxically, there was no difference in functional independence (mRS 0–2) (OR 1.09, 95% CI 0.99–1.20). Additionally, tenecteplase or alteplase at doses equivalent to 25% or 50% of recommended IV dosage significantly improved excellent functional outcome.

IA thrombolysis offered immediately following EVT with successful reperfusion improved excellent functional outcome and recovery without disability at 90 days with an acceptable safety profile.

Gut microbiota (GM) affects muscle homeostasis, and growing evidence indicates dysbiosis of GM may be a contributing factor in the pathogenesis of dystrophies. Furthermore, GM metabolites can interact with DNA methylation. Facioscapulohumeral muscular dystrophy (FSHD) is the second common dystrophy with hypomethylation of DR1 and 5P regions of D4Z4 repeat on 4qter.

Considering alteration of GM may be a contributing factor, we investigated (i) GM alterations and (ii) the correlation of microbial-derived free fatty acids (FFAs) with methylation of DR1 and 5P regions in FSHD.

Twenty-eight FSHD patients and 28 gender-age-matched controls were included. GM characterisation was performed through 16S-rRNA sequencing. Methylation levels of DR1 and 5P regions were assessed by bisulphite sequencing. Faecal and circulating FFAs including short-chain fatty acids (SCFAs), medium-chain fatty acids (MCFAs) and long-chain fatty acids (LCFAs) were analysed with gas chromatography-mass spectrometry.

Altered GM was observed in patients, along with distinct profiles of faecal and circulating SCFAs, MCFAs and LCFAs. DR1 and 5P regions exhibited significant hypomethylation in FSHD compared to control. Hypomethylation correlated with faecal and circulating FFAs in patients, while no correlation was identified in healthy controls. The severely affected patients exhibited a notable increase in the prevalence of Pasteurellaceae, while the FFA profile was similar among mild and severely affected patients. This is the first study revealing that FSHD patients showed compositional and functional GM dysbiosis. A strong association between proximal D4Z4 hypomethylation with microbial-derived SCFAs was identified.

These findings suggest that GM modulation with its metabolites could be a promising strategy for interventions in FSHD management.

Since cannabis was legalized in Canada in 2018, its use among older adults has increased. Although cannabis may exacerbate cognitive impairment, there are few studies on its use among older adults being evaluated for cognitive disorders.

We analyzed data from 238 patients who attended a cognitive clinic between 2019 and 2023 and provided data on cannabis use. Health professionals collected information using a standardized case report form.

Cannabis use was reported by 23 out of 238 patients (9.7%): 12 took cannabis for recreation, 8 for medicinal purposes and 3 for both purposes. Compared to non-users, cannabis users were younger (mean ± SD 62.0 ± 7.5 vs 68.9 ± 9.5 years; p = 0.001), more likely to have a mood disorder (p < 0.05) and be current or former cigarette smokers (p < 0.05). There were no significant differences in sex, race or education. The proportion with dementia compared with pre-dementia cognitive states did not differ significantly in users compared with non-users. Cognitive test scores were similar in users compared with non-users (Montreal Cognitive Assessment: 20.4 ± 5.0 vs 20.7 ± 4.5, p = 0.81; Folstein Mini-Mental Status Exam: 24.5 ± 5.1 vs 26.0 ± 3.6, p = 0.25). The prevalence of insomnia, obstructive sleep apnea, anxiety disorders, alcohol use or psychotic disorders did not differ significantly.

The prevalence of cannabis use among patients with cognitive concerns in this study was similar to the general Canadian population aged 65 and older. Further research is necessary to investigate patients’ motivations for use and explore the relationship between cannabis use and mood disorders and cognitive decline.

Although carotid endarterectomy (CEA) or carotid artery stenting (CAS) is recommended for symptomatic extracranial carotid stenosis of 50–99%, the COVID-19 pandemic significantly impacted resources. CAS therefore offered potential advantages as access to the angiosuite was seemingly easier than access to operating rooms. The primary objective was to determine the frequency of serious and non-serious complications following CAS before and during the COVID-19 pandemic.

We performed a retrospective cohort study of consecutive patients who received CAS at the Ottawa Hospital, Canada, from June 2019 to May 2021. We reviewed baseline demographics, imaging, as well as intraprocedural and postprocedural complications based on chart review. We performed multivariable logistic regression to determine associations between clinical and safety outcomes.

We included 47 patients in the pre-pandemic period and 93 patients in the pandemic period (mean age = 70.4 years; 54% female; P = 0.287 for age and P = 0.962 for sex, respectively). The combined rate of intraprocedural and postprocedural serious complications (ischemic stroke, intracerebral hemorrhage, myocardial infarction or death) was 7.1%. Eight strokes occurred, and one patient with a postprocedural ischemic stroke died 11 days after stenting. Complication rates were similar before and during the pandemic (aOR 1.040, 95% CI 0.466–2.321). The number of referrals for CEA during the pandemic period decreased by 50%.

In this cohort of consecutive patients undergoing CAS at a Canadian comprehensive stroke center before and during the COVID-19 pandemic, the rates of stroke and death were similar to pre-pandemic conditions and were generally consistent with the published literature.

Stroke is a devastating disease, but the disability due to stroke can be avoided or reduced through timely access to treatment and care. This study surveyed all designated stroke centres across Canada to better understand the national acute stroke treatment landscape.

An online survey designed to obtain information on each stroke hospital’s designation level, most responsible physician for acute reperfusion treatment decision-making, availability of stroke coordinators, stroke research activity and level of transition to tenecteplase for intravenous thrombolysis was distributed to stroke centres in Canada via a network of stroke administrators and physician leads from each province. The survey responses were collated and audited for completeness and accuracy, and final responses were analysed using descriptive statistics and graphical distributions as appropriate.

There are a total of 205 designated stroke centres in Canada; 13.2% (n = 27) are endovascular thrombectomy (EVT) capable (n = 26 provide 24/7 access), while the rest provide thrombolysis alone, comprising primary stroke centres (n = 70, 34.1%) and thrombolysis-ready centres (n = 108, 52.7%). The presence of neurologists in the thrombolysis-capable centres is minimal, although compensated for by a high use of telestroke in making thrombolysis decisions. Participation rate in stroke clinical trials was heavily restricted to the EVT-capable centres. There were variabilities among provinces in the availability of stroke coordinators.

The acute ischaemic stroke landscape in Canada is variable between provinces, presenting unique opportunities for collaboration. There is a need for greater availability of stroke neurologists and stroke coordinators and for diversifying site participation in clinical trials.