Endovascular Thrombectomy (EVT) is a standard of care for clinical management of ischemic stroke patients. Highly selected patients with large ischemic stroke and large artery occlusion may benefit from EVT up to 24 hours from the time they were last known well, including patients with stroke on awakening.
For additional information on acute stroke management refer to the Canadian Stroke Best Practice Recommendations #5 Acute Ischemic Stroke Treatment 2018 Update.
The EVT Toolkit has been developed to help Central East Stroke Network organizations with the implementation of a Large Vessel Occlusion Stroke Screening Tool (ACT-FAST) and guide the decision making in the eligibility for EVT. The screen has high specificity and reliability for recognizing large vessel occlusions in severe anterior circulation stroke (Zhao et al., 2018).
The toolkit is for community non-tPA hospitals and is intended for use by organizations’ clinicians including, educators, managers, resource nurses, coordinators, nurses and physicians. Each tab contains resources that can be modified for your site as well as district-specific resources.
EVT is a highly specialized procedure involving the mechanical removal of a clot in the brain. The procedure is performed by specialists with neurointerventional expertise at EVT Centres. The procedure is for patients with large vessel occlusions. Using advanced imaging, a guide wire is introduced into the femoral artery and guided up to and through the clot. The guide wire is removed, and a stent is inserted and deployed. The clot is encapsulated by the stent and then is mechanically removed.
Medtronic Innovation Helps Yoga Mom Survive a Stroke – Click Here to view video clip
Dr. Timo Krings on why he loves helping patients – Krembil Brain Institute – Click Here to view video clip
Time and Teamwork in Stroke Care – Click Here to view video clip
Mechanical Thrombectomy at the Cleveland Clinic – Click Here to view a short video clip that demonstrates how the procedure is done
This video (18 min) was developed by Dr. Blair Bigham in collaboration with the Central East Stroke Network. It provides information for emergency doctors who work in hospitals without comprehensive stroke teams, on-call stroke neurologists or neurointerventional programs. The video discusses indications for EVT, various large vessel stroke syndromes, and the steps needed to refer to a neurointerventionalist.
Created by Dr. Blair Bigham MD MSc DTMH FRCPC an Emergency Physician in the Durham Region, Ontario
Additional Resources as outlined in the video include:
EVT +/- Lysis: The future of Stroke? Blog on SGEM and ACEPNow:
For hospital specific documents please refer to your organization’s usual process for developing and accessing policies and procedures – this section in development
Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 4-24 Hours of Stroke Symptom Onset
Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 6-24 Hours of Stroke Symptom Onset
Project Lead: Cheryl Moher
T: 705-928-9090 ext. 46300 Email: firstname.lastname@example.org
Clinical Nurse Specialist: Shannon Doucette
Medical Director: Dr. Alex Jahangirvand
District Stroke Coordinator: Amy Gargal
T: 705-789-2311 ext. 2510 Email: email@example.com
Stroke Nurse Specialist: Donna Crump
Medical Director: Dr. T Lapp
District Stroke Coordinator: Erin McHattie
T: 705 743 2121 ext. 3946 Email: firstname.lastname@example.org
Advance Practice Stroke Nurse: Cindy Hill
T: 705–743-2121 ext. 4144 Email: email@example.com
District Stroke Coordinator: Amy Maebrae Waller
Clinical Nurse Specialist: Laura MacIsaac
Medical Director: Dr. Lancy Wang
District Stroke Coordinator: Yasmin Visram