Access to Endovascular Thrombectomy for Stroke in Rural Versus Urban Regions

Yan, Yongping; Hu, Keqi; Alcock, Susan; Ghrooda, Esseddeeg; Trivedi, Anurag; McEachern, James; Kaderali, Zul; Shankar, Jai

doi:10.1017/cjn.2021.35

Cited by 9 publications

(7 citation statements)

References 25 publications

(31 reference statements)

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“…54 Furthermore, suboptimal MT access in HIC indicates that despite adequate resources, there are gaps in achieving optimized, coordinated regional systems of stroke care. Reported barriers have included geographical, [55][56][57] logistical, 58 financial, 59 and sociocultural. 60,61 The availability of MT centers was associated with MT access rate in our study.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

et al. 2023

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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was <1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower–middle versus high: odds ratio, 0.08 [95% CI, 0.04–0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07–5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84–4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70–9.42]) were significantly associated with increased odds of MTA. Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

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Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

et al. 2023

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“…The proportion of patients in the hyperacute group was similar among the groups, and the relationship with the outcome was either similar or slightly worse in the hyperacute cohort than X [please define X]. A nearly linear dose- rates, they often did not specify whether these differences were due to factors before or after hospital admission 7,12,[32][33][34][35] . Our analysis included a similar proportion of hyperacute cases from both rural and urban areas, suggesting that poorer outcomes in rural settings might be related more to in-hospital factors relevant confounders, such as the clinical type of AIS, thus providing a particularly nuanced perspective.…”

Section: Key Observationsmentioning

confidence: 99%

Regional Disparities in Hyperacute Treatment and Functional Outcomes after Acute Ischemic Stroke in Japan

Fujiwara,

Kondo,

Oka

et al. 2024

JAT

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BackgroundAcute ischemic stroke (AIS) is a major health challenge affecting approximately 15 million people globally each year, of whom 5 million die and another 5 million are permanently disabled, imposing major burdens on families and society 1,2) . The incidence, treatment, and outcomes of AIS can vary based on a broad range of social factors, making it a multifaceted issue that transcends medical and healthcare boundaries. In North America and China, AIS mortality is reportedly higher in remote and rural areas than in urban areas; however, the reasons for this disparity are not well understood [3][4][5][6] . Factors hypothesized to explain this observation include a higher AIS incidence, uneven distribution of Aim: This study investigated the impact of rurality on acute ischemic stroke (AIS) outcomes, emphasizing the hyperacute phase, in which immediate care is crucial. Methods: This retrospective cohort study analyzed data from a large Japanese hospital network covering AIS patients from 2013-2021, was analyzed. The focus was on patients admitted within 4.5 h of the onset, using the Rurality Index for Japan (RIJ) to categorize patients into rural or urban groups. This study examined treatment methods (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) and functional outcomes measured using the modified Rankin Scale (mRS), where scores of 3-6 indicated poor outcomes. Multilevel logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for poor outcomes based on rurality. The study also evaluated the population-attributable fraction (PAF) to estimate potential outcome improvements in urban settings. Results: Of 27,691 patients, 17,516 were included in the total cohort and 4,954 in the hyperacute cohort. Urban patients constituted 73.7% (12,902), with higher IVT (5.2%) and MT (3.6%) rates than rural patients (4.1% IVT, 2.0% MT). Poor mRS outcomes were more common in rural areas than in urban areas, with adjusted ORs of 1.30 (1.18-1.43) in the total cohort and 1.43 (1.19-1.70) in the hyperacute cohort. The PAF for poor outcomes due to rural residency was 14.8% (0.5%-31.0%). Conclusion:This study demonstrated a notable association between rurality and poorer AIS outcomes in Japan, particularly in the hyperacute phase.

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“…12 Beyond mobile stroke units, timely treatment was examined as an outcome of bypass and secondary transfer emergency care models in Canada, Australia, England, and China. Secondary transfer policies were recommended in Canada to improve access to endovascular therapy for patients in rural locations, 13 and authors made a case for maintaining secondary transfer from highly efficient primary stroke centers in Melbourne (Australia), although direct bypass resulted in faster treatment. 14 Examination of almost 250 000 acute stroke admissions over 3 years in England found bypassing local stroke centers for direct transport to a thrombectomy center could challenge the sustainability of intravenous thrombolysis expertise in smaller centers and volume at larger hospitals.…”

Section: Acute Stroke Care and Costsmentioning

confidence: 99%