(705) 728-9090 x46320 | 201 Georgian Drive. Barrie, ON L4M 6M2

Central East Stroke Network

Endovascular Therapy


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.    


4-24hr EVT Toolkit for Non-tPA Sites

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

When should my stroke patient be sent for EVT? What Emergency Doctors Need to Know!

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:

TPA Evidence Review (42 min, free online, U. Ottawa “A stroke of luck” Jul 2021):  Thrombolytics – A Stroke of Luck

EVT Evidence Review

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

North Simcoe Muskoka

Simcoe Muskoka Acute Stroke Protocol

Lakeridge Health


North Simcoe Muskoka
  • Click on Image to view the NSM ACT-FAST Stroke Screening Training Video


Click on the image or scan the QR code to view the HKPR ACT FAST Screening Educational Video


Lakeridge Health
  • Click on image to view the York ACT-FAST Stroke Screening Training Video


National Institutes of Health Stroke Scale (NIHSS) – Training for ED Physicians (no cost)

  • Scoring Template – paper copy that can be used to assist with scoring NIHSS
  • Scoring Tools/apps:
  • Apple Store – NIHSS Stroke Scale – Inneva Pharma SL (there is an associated cost to purchase app)
  • Google Play – 


Canadian Neurological Scale (CNS) – Nursing

CESN Regional Stakeholder Session – September 30th, 2021

Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 4-24 Hours of Stroke Symptom Onset

CESN Regional Consultation – March 5th, 2020

Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 6-24 Hours of Stroke Symptom Onset

Simcoe District Stakeholder Session – October 20, 2021

Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 6-24 Hours of Stroke Symptom Onset


HKPR District Stakeholder Sessions 

CESN 4-24 Hour EVT Access for Non-Designated Sites in HKPR_21October21

CMH to KGH CESN 4-24 Hour EVT Access for Non-Designated Sites_03November 2021

Pre-Launch Checklist 

Supports the organization in identifying and tracking the steps in the rollout of the 4-24hr window. CLICK HERE to download

Frequently Asked Questions (FAQs) – section in development
Provincial Stroke Repatriation Reference Document Sept 2021
CorHealth Ontario Endovascular Treatment Resource Centre 

Project Lead:  Cheryl Moher

T:    705-928-9090 ext. 46300         Email: moherc@rvh.on.ca

Clinical Nurse Specialist: Shannon Doucette

Email: doucettes@rvh.on.ca

Medical Director:  Dr. Alex Jahangirvand


District Stroke Coordinator: Amy Gargal

T: 705-789-2311  ext. 2510    Email:  amy.gargal@mahc.ca

Stroke Nurse Specialist: Donna Crump

Email:  Donna.Crump@mahc.ca

Medical Director: Dr. T Lapp

Haliburton Kawartha Pine Ridge (HKPR)

District Stroke Coordinator:  Erin McHattie

T: 705 743 2121  ext. 3946            Email: emchatti@prhc.on.ca

Advance Practice Stroke Nurse:  Cindy Hill

T:  705–743-2121  ext. 4144         Email:  chill@prhc.on.ca

Lakeridge Health

District Stroke Coordinator: Amy Maebrae Waller 

Email: AWaller@lh.ca

Clinical Nurse Specialist:  Laura MacIsaac 

Email: lmacisaac@lh.ca

Medical Director:  Dr. Lancy Wang


District Stroke Coordinator:  


Looking for local community resources? Please visit the links below for more information:

Central East Line
Central Health Line
NSM Health Line