Northwestern Ontario Regional Stroke Network

Acute Stroke Protocol

In February 2021, the Provincial Hyperacute Stroke Care Steering Committee recommended that Ontario move forward with a 24-hour hyperacute stroke treatment window for selected patients. While the evidence for thrombolysis (Alteplase) for ischemic stroke remains at 4.5 hours from when the patient was last known to be well, the evidence for Endovascular Thrombectomy (EVT) has demonstrated benefit for selected patients in this longer time window. Hospitals should screen for potentially eligible patients and enact an appropriate consult to confirm this eligibility.
To further support this transition, the Northwestern Ontario Regional Stroke Network (NWORSN) has updated regional Acute Stroke Protocol pathways to include the expanded 24-hour EVT treatment window in September 2022.

For the following patient criteria, the Acute Stroke Physician remains available 24/7:

• Positive FAST, last known well time of 0-4.5 hours
• Positive ACT-FAST, last known well time of 4.5-24 hours

For the following patient criteria, the Acute Stroke Physician is available during consulting hours:

• Positive FAST, last known well time of 4.5-24 hour and a negative ACT-FAST screen
• Positive FAST, last known well time >24 hour
• Consulting Hours: Monday to Sunday 0800-2330 EST, effective immediately.