Challenges to Widespread Implementation of Stroke Thrombectomy
Johanna M. Ospel, William K. Diprose, Aravind Ganesh, Sheila Martins, Thanh N. Nguyen, Marios Psychogios, Ossama Mansour, Fahad Al-Ajlan, Pengfei Yang, Jeyaraj Pandian, Anil Gopinathan, Else Charlotte Sandset, James Kennedy, David Volders, Robert Fahed, Stavropoula Tjoumakaris, Pervinder Bhogal, Martin Kurz, Dileep Yavagal, Violiza Inoa, Michael D. Hill, Mayank Goyal
Abstract
Endovascular treatment (EVT) for acute ischemic stroke is one of the most efficacious and effective treatments in medicine, yet globally, its implementation remains limited. Patterns of EVT underutilization exist in virtually any health care system and range from a complete lack of access to selective undertreatment of certain patient subgroups. In this review, we outline different patterns of EVT underutilization and possible causes. We discuss common challenges and bottlenecks that are encountered by physicians, patients, and other stakeholders when trying to establish and expand EVT services in different scenarios and possible pathways to overcome these challenges. Lastly, we discuss the importance of implementation research studies, strategic partnerships, and advocacy efforts to mitigate EVT underutilization.