Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study
Kaiz Asif, Fadar Oliver Otite, Shashvat M. Desai, Nabeel Herial, Violiza Inoa, Fawaz Al‐Mufti, Ashutosh P. Jadhav, Adam A. Dmytriw, Alicia C. Castonguay, Priyank Khandelwal, Jennifer Potter‐Vig, Viktor Szeder, Tanzila Kulman, Victor Urrutia, Hesham Masoud, Gábor Tóth, Kaustubh Limaye, Sushanth Aroor, Waleed Brinjikji, Ansaar Rai, Jeyaraj Pandian, Mehari Gebreyohanns, Thomas Leung, Malek Mansour, Andrew M. Demchuk, Vikram Huded, Sheila Cristina Ouriques Martins, Osama O. Zaidat, Xiaochuan Huo, Bruce Campbell, PN Sylaja, Zhongrong Miao, Jeffrey L. Saver, Santiago Ortega‐Gutiérrez, Dileep R. Yavagal, Juan Cirio, Pedro Lylyk, Ángel Ferrario, Luis Lemme Plaghos, José Luis ́Blas Arroyo, Bernard Yan, Ronil V. Chandra, Wael Hamed Ibrahim, Firas Alnidawi, Sirajee Shafiqul Islam, Mohammad Shahidullah, Víctor Villarroel Saavedra, Francisco Josà Mont’ Alverne, Pedro Magalhães, Gisele Sampaio Silva, Stanimir Sirakov, Rosen Kalpachki, Nurfet Alioski, Eric Gueumekane Bila Lamou, Jai Shankar, Grant Stotts, Daidre Rowe, Francene Gayle, Romnesh de Souza, Cristina Ramos, Amaury GarcÃa, Amza Ali, Sherry Sandy, Pablo M. Lavados, Rodrigo Rivera, Tony Fabian Alvarez Guzman, Alejandro Villarraga, Carolina Estrada, B Pabón, Antonı́n Krajina, Aleš Tomek, Philip Adebayo, GERMAN ABDO, Nelson Maldonado S, Farouk Hassan, Eman M. Khedr, Mirza Khinikadze, Zurab Nadareishvili, Alexander Tsiskaridze, Νikolaos Syrmos, Panayiotis Mitsias, Biplab Das, Jayanta Roy, Vivek Gupta, Vipul Gupta, Dheeraj Khurana, Anil Karapurkar, M.V.Padma Stivastava, Anand Alurkar, Arvind Sharma, Satish Lahoti, Rahul Kumar, Gigy Kuruttukulam, Achmad Firdaus Sani, Ita Muharram Sari, Mustafa Saleem Khassaf, Temeem Majid Nassir, Nobuyuki Sakai, Hiroshi Yamagami, Haitham Dababneh
Abstract
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.