Grant: Canada Postdoctoral Research Award (CPRA) program

Stroke happens when blood flow to a part of the brain gets interrupted, usually by a clot. This can damage brain cells and affect speech, movement, memory, or even result in death. While some people recover well, others face more challenges. This project aims to understand why recovery from stroke differs from one person to another. We will study patients from a large Canadian stroke studies called the AcT WHEN and DOSE trials. In the ongoing AcT WHEN trial, the effectiveness of a lower dose of Tenecteplase, a clot-busting medication, is being compared to the standard dose for safety issues. In the DOSE trial, we are testing the safety and effectiveness of giving Tenecteplase to patients who have recently taken blood-thinning medications called DOACs (direct oral anticoagulants). Stroke severity is measured on arrival for all patients. We will group patients based on how severe their strokes were, and examine their brain scans taken at the time of arrival and 24 hours later. Furthermore, we will look at signs of brain aging, which we call "brain frailty". These signs include shrinking of brain tissue, damage to small blood vessels, and old small strokes (lacunes). People with more of these signs may have less brain "reserve" or "strength" to recover from a new stroke. This study will explore whether brain frailty leads to larger areas of brain injury and poorer recovery after 90 days. We will also examine whether the two stroke medications work differently in patients with stronger versus frailer brains. Through learning how brain health and stroke severity interact, we hope to help physicians better predict recovery and tailor treatments to each patient's needs. This will support more personalized stroke care and improve long-term outcomes for patients.