The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

Study design: Cross-sectional study comparing healthy subjects with age and gender matched subjects with spinal cord injury (SCI, injury levels from C5 to T12). Objectives: To compare the acute cardiorespiratory responses and muscle oxygenation trends during functional electrical stimulation (FES) cycle exercise and recovery in the SCI and healthy subjects exercising on a mechanical cycle ergometer. Setting: Seven volunteers in each group participated in one exercise test at the Rick Hansen Center, University of Alberta, Edmonton, Canada. Methods: Both groups completed a stagewise incremental test to voluntary fatigue followed by 2 min each of active and passive recovery. Cardiorespiratory responses were continuously monitored using an automated metabolic cart and a wireless heart rate monitor. Tissue absorbency, an index of muscle oxygenation, was monitored non-invasively from the vastus lateralis using near infrared spectroscopy. Results: The healthy subjects showed signi®cant (P50.05) increases in the oxygen uptake (V . O 2 ), heart rate (HR) and ventilation rate (V . E ) from rest to maximal exercise. The SCI subjects showed a twofold increase in V . O 2 (P40.05), a threefold increase in V . E (P50.05) and a 5 beats/min increase in HR (P40.05) from the resting value. The SCI subjects demonstrated a lesser degree (P50.05) of muscle deoxygenation than the healthy subjects during the transition from rest to exercise. Regression analysis indicated that the rate of decline in muscle deoxygenation with respect to the V . O 2 was signi®cantly (P50.05) faster in the SCI subjects compared to healthy subjects. Conclusions: FES exercise in SCI subjects elicits: (a) modest increases in the cardiorespiratory responses when compared to resting levels; (b) lower degree of muscle deoxygenation during maximal exercise, and (c) faster changes in muscle deoxygenation with respect to the V . O 2 during exercise when compared to healthy subjects. Spinal Cord (2000) 38, 630 ± 638

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