J Stroke.  2022 Jan;24(1):41-48. 10.5853/jos.2021.03909.

Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States

• Aroor SR
• Asif KS
• Potter-Vig J
• Sharma A
• Menon BK
• Inoa V
• Zevallos CB
• Romano JG
• Ortega-Gutierrez S
• Goldstein LB
• Yavagal DR

• KMID: 2525329
• DOI: http://doi.org/10.5853/jos.2021.03909

Abstract

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention.

Keyword

Stroke; Triage; Public health; Thrombectomy; Ischemic stroke; Healthcare disparities

Figure

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  Figure 1. Factors contributing to delay in the information and diagnostic access leading to decreased odds of good functional outcome (modified Rankin Scale [mRS] 0–2) for mechanical thrombectomy. CTP, computerized tomography perfusion; CSC, comprehensive stroke center; TSC, thrombectomy capable stroke center; EDP, emergency department physician; LVO, large vessel occlusion; CTA, computed tomography angiogram; CT, computed tomography; DIDO, door in-door out; ASRH, acute stroke ready hospital; PSC, primary stroke center; EMS, emergency medical service. *Not to scale.

Reference

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