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

Nasreldein A 1 , Wan Asyraf WZ 2 , Nguyen TN 3 , Martins SO 4 , Lioutas VA 5 , Elbassiouny A 6 Show all authors , Mai TD 7 , Sacco S 8 , Micdhadhu M 9 , Chen Y 10 , Akinyemi R 11 , Kristoffersen ES 12 , Huo X 13 , Miao Z 14 , Abdalkader M 15 , Nagel S 16 , Puetz V 17 , Thomalla G 18 , Yamagami H 19 , Qiu Z 20 , Demeestere J 21 , Qureshi AI 22 , Michel P 23 , Strbian D 24 , Campbell B 25 , Yan B 26 , Olorukooba A 27 , Masoud HE 28 , Haussen DC 29 , Frankel MR 30 , Mohammaden MH 30

Affiliations 

  • 1 Department of Neurology, Assiut University, Assiut, Egypt
  • 2 Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
  • 3 Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA
  • 4 Department of Neurology, Hospital Moinhos de Vento and Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
  • 5 Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 6 Department of Neurology, Ain-Shams University, Cairo, Egypt
  • 7 Stroke Center, Bach Mai Hospital; VNU- University of Medicine and Pharmacy, Hanoi Medical University, Hanoi, Vietnam
  • 8 Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
  • 9 Department of Neurology, Hospital Seberang Jaya, Pulau Pinang, Malaysia
  • 10 Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
  • 11 Neuroscience and Aging Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
  • 12 Department of Neurology, Akershus University Hospital, Akershus, Norway
  • 13 Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • 14 Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
  • 15 Department of Radiology, Boston Medical Center, Boston, USA
  • 16 Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
  • 17 Department of Neurology and Dresden Neurovascular Center, University Hospital Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
  • 18 Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  • 19 Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Japan
  • 20 Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
  • 21 Department of Neurology, Leuven University Hospital, Leuven, Belgium
  • 22 Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, USA
  • 23 Lausanne University Hospital, Lausanne, Switzerland
  • 24 University of Helsinki, Neurology, Helsinki, Finland
  • 25 Royal Melbourne Hospital¸ University of Melbourne, Melbourne, Australia
  • 26 Royal Melbourne Hospital, Radiology, Parkville, VIC, Australia
  • 27 Faculty of Clinical Sciences, College of Medical Sciences Ahmadu Bello University, Zaria, Department of Community Medicine, Kaduna State, Nigeria
  • 28 Department of Neurology, State University of New York, Syracuse, USA
  • 29 Emory University School of Medicine, Neurology, Atlanta, United States
  • 30 Department of Neurology, Grady memorial Hospital, Emory University, Atlanta, USA
Int J Stroke, 2025 Jan 07.
PMID: 39773209 DOI: 10.1177/17474930251314395

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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