Global Challenges in the Access of Endovascular Treatment for Acute Ischemic Stroke (Global MT Access)

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Ahmed Nasreldein - , Assiut University (Author)
  • Wan Zaidi Wan Asyraf - , Universiti Kebangsaan Malaysia (Author)
  • Thanh N Nguyen - , Boston Medical Center (BMC) (Author)
  • Sheila Ouriques Martins - , Hospital Moinhos de Vento, Hospital de Clínicas de Porto Alegre (Author)
  • Vasileios-Arsenios Lioutas - , Beth Israel Deaconess Medical Center (BIDMC) (Author)
  • Ahmed Elbassiouny - , Ain Shams University (Author)
  • Ton Duy Mai - , VNU University of Medicine and Pharmacy, Bach Mai Hospital, Hanoi Medical University (Author)
  • Simona Sacco - , University of L'Aquila (Author)
  • Mohamed Micdhadhu - , Seberang Jaya Hospital (Author)
  • Yimin Chen - , Foshan Sanshui District People‘s Hospital (Author)
  • Rufus Akinyemi - , University of Ibadan (Author)
  • Espen Saxhaug Kristoffersen - , Akershus University Hospital (Ahus) (Author)
  • Xiaochuan Huo - , Capital Medical University (CMU) (Author)
  • Zhongrong Miao - , Beijing Tiantan Hospital (Author)
  • Mohamad Abdalkader - , Boston Medical Center (BMC) (Author)
  • Simon Nagel - , Klinikum Ludwigshafen (Author)
  • Volker Puetz - , Department of Neurology, Dresden Neurovascular Center, University Hospital Carl Gustav Carus Dresden (Author)
  • Götz Thomalla - , University Hospital Hamburg Eppendorf (Author)
  • Hiroshi Yamagami - , University of Tsukuba (Author)
  • Zhongming Qiu - , The 903rd Hospital of the Chinese People's Liberation Army (Author)
  • Jelle Demeestere - , University Hospitals Leuven (Author)
  • Adnan I Qureshi - , University of Missouri (Author)
  • Patrik Michel - , University Hospital of Lausanne (CHUV) (Author)
  • Daniel Strbian - , Helsinki University Hospital (HUS) (Author)
  • Bruce Campbell - , Royal Melbourne Hospital (Author)
  • Bernard Yan - , Royal Melbourne Hospital (Author)
  • Abdulhakeem Olorukooba - , Ahmadu Bello University (Author)
  • Hesham E Masoud - , SUNY Upstate Medical University (Author)
  • Diogo C Haussen - , Grady Health System (Author)
  • M R Frankel - , Grady Health System (Author)
  • Mahmoud H Mohammaden - , South Valley University (Author)

Abstract

BACKGROUND: Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.

AIM: Our aim was to determine the key challenges for MT implementation and access worldwide.

METHODS: We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network, and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country.

RESULTS: We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43(8.2%) had available MT only during working hours, 362(68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used Non-contrast Computed Tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography /CT perfusion), 0.4% used Magnetic Resonance Imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neuro-interventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities and lack of collaboration between departments were the most common obstacles against developing a training program.

CONCLUSION: Our study highlights significant variations in MT availability, accessibility, patient selection criteria and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.

Details

Original languageEnglish
JournalInternational Journal of Stroke
Publication statusE-pub ahead of print - 7 Jan 2025
Peer-reviewedYes

External IDs

unpaywall 10.1177/17474930251314395