Grant: Project Grant

Most minor strokes are due to lack of blood getting to a part of the brain. When this occurs, patients get sudden loss of function in that region of the brain. This might mean inability to move a limb or inability to speak. In the luckiest case, this dysfunction resolves rapidly by itself and we call it a transient ischemic attack (TIA). If less lucky, the disability persists due to a minor stroke. Minor stroke and TIA account for about 50% of all strokes in Canada. Most physicians think that patients with minor stroke or TIA do not need aggressive treatment with clot busting drugs because the risk of bleeding in the brain is greater than any benefit. However, we believe that this judgment is incorrect. We have shown that minor stroke and TIA patients with evidence of a blocked blood vessel on a brain scan are at a very high risk of being left disabled with conservative treatment. This subgroup of patients can benefit from aggressive therapy with clot-busting drugs. The usual clot-busting drug usually used in Stroke is called tPA. A newer drug used in patients with heart attack called TNK works faster and is safer than tPA. In the TEMPO-2 clinical trial, we will determine if TNK, given as a single dose, is better than usual care for patients with minor stroke with a proven blocked artery. Patients will have a 50:50 chance (i.e. like the toss of a coin) of getting either treatment or usual care. Patients will be assessed 3 months after the event for evidence of disability. If this study shows that the clot busting medicine should be used in minor stroke and TIA with blocked blood vessels then this will change care of patients throughout the world.