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

Kaiz S. Asif; Fadar O. Otite; Shashvat M. Desai; Nabeel Herial; Violiza Inoa; Fawaz Al-Mufti; Ashutosh P. Jadhav; Adam A. Dmytriw; Alicia Castonguay; Priyank Khandelwal; Jennifer Potter-Vig; Viktor Szeder; Tanzila Kulman; Victor Urrutia; Hesham Masoud; Gabor Toth; Kaustubh Limaye; Sushanth Aroor; Waleed Brinjikji; Ansaar Rai; Jeyaraj Pandian; Mehari Gebreyohanns; Thomas Leung; Ossama Mansour; Andrew M. Demchuk; Vikram Huded; Sheila Martins; Osama Zaidat; Xiaochuan Huo; Bruce Campbell; P. N. Sylaja; Zhongrong Miao; Jeffrey Saver; Santiago Ortega-Gutierrez; Dileep R. Yavagal; Juan Jose Cirio; Pedro Lylyk; Angel Ferrario; Luis Lemme Plaghos; José Arroyo; Bernard Yan; Ronil Chandra; Wael Hamed Ibrahim; Firas Alnidawi; Sirajee Shafiqul Islam; Mohammad Shahidullah; Víctor Villarroel Saavedra; Francisco Josã Mont Alverne; Pedro Magalhaes; 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 Fabián Álvarez Guzmán; Alejandro Villarraga; Carolina Estrada; Boris Pabon; Antonin Krajina; Aleš Tomek; Philip B. Adebayo; German Abdo; Nelson Maldonado S; Farouk Hassan; Eman M. Khedr; Mirza Khinikadze; Zurab Nadareishvili; Alexander Tsiskaridze; Nikolaos 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 Varkey Kuruttukulam; Achmad Firdaus Sani; Ita Muharram Sari; Mustafa Khassaf; Temeem Majid Nassir; Nobuyuki Sakai; Hiroshi Yamagami; Haitham Dababneh; Farid A. Aladham; Mynzhylky Berdikhojayev; Sabina Medukhanova; Raghid Kikano; Ali Alaraj; Rechdi Ahdab; Wan Asyraf Wan Zaidi; Khairul Azmi Abd Kadir; Antonio Arauz; Fernando Gongora; Ariunaa Jambaldorj; Ganbaatar Xxx; Zarni Myint Shwe; Win Min Thit; Anna Ranta; Teddy Wu; Erwin E. Rayo; Mayowa Owolabi; Akintomiwa Makanjuola; Saima Ahmad; Mohammad Wasay; Umair Rashid; Ricardo Mernes; Osvaldo Paniagua; Marla Gallo; Manuel Moquillaza; Maria Epifania Collantes; Manuel M. Mariano; Adam Kobayashi; Rafael Rodriguez-Mercado; Rodolfo Alcedo Guardia; Yahia Imam; Ayman Zakaria Ahmed; Adel Alhazzani; Hosam M. Al-Jehani; Wickly Lee; Kamil Zeleňák; Andrej Klepanec; Georgi Krastev; Senta Frol; Naeem Brey; Anastasia Rossouw; Prasad De Silva; Harsha Gunasekera; Udaya Ranawaka; Haytham Osman; Sarah M. El-Sadig; Nijasri C. Suwanwela; Wasan Akarathanawat; Jarturon Tantivatana; Nadia Hammami; Samia Ben Sassi; Atilla Ozcan Ozdemir; Semih Giray; Dmytro Lebedynets; Stanislav Konotopchik; Seby John; Syed Irteza Hussain; Robin Novakovic-White; Atilla Ozcan Ozdemir; Semih Giray; Gillian L. Gordon Perue; Ryna Then; Claudio Berrutti; Roberto Crosa; Huy Thang Nguyen; Huynh Vu Le; Tran Thanh Vu

doi:10.1161/CIRCULATIONAHA.122.063366

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

Kaiz S. Asif, Fadar O. Otite, Shashvat M. Desai, Nabeel Herial, Violiza Inoa, Fawaz Al-Mufti, Ashutosh P. Jadhav, Adam A. Dmytriw, Alicia Castonguay, Priyank Khandelwal, Jennifer Potter-Vig, Viktor Szeder, Tanzila Kulman, Victor Urrutia, Hesham Masoud, Gabor Toth, Kaustubh Limaye, Sushanth Aroor, Waleed Brinjikji, Ansaar RaiJeyaraj Pandian, Mehari Gebreyohanns, Thomas Leung, Ossama Mansour, Andrew M. Demchuk, Vikram Huded, Sheila Martins, Osama Zaidat, Xiaochuan Huo, Bruce Campbell, P. N. Sylaja, Zhongrong Miao, Jeffrey Saver, Santiago Ortega-Gutierrez, Dileep R. Yavagal, Juan Jose Cirio, Pedro Lylyk, Angel Ferrario, Luis Lemme Plaghos, José Arroyo, Bernard Yan, Ronil Chandra, Wael Hamed Ibrahim, Firas Alnidawi, Sirajee Shafiqul Islam, Mohammad Shahidullah, Víctor Villarroel Saavedra, Francisco Josã Mont Alverne, Pedro Magalhaes, 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 Fabián Álvarez Guzmán, Alejandro Villarraga, Carolina Estrada, Boris Pabon, Antonin Krajina, Aleš Tomek, Philip B. Adebayo, German Abdo, Nelson Maldonado S, Farouk Hassan, Eman M. Khedr, Mirza Khinikadze, Zurab Nadareishvili, Alexander Tsiskaridze, Nikolaos 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 Varkey Kuruttukulam, Achmad Firdaus Sani, Ita Muharram Sari, Mustafa Khassaf, Temeem Majid Nassir, Nobuyuki Sakai, Hiroshi Yamagami, Haitham Dababneh, Farid A. Aladham, Mynzhylky Berdikhojayev, Sabina Medukhanova, Raghid Kikano, Ali Alaraj, Rechdi Ahdab, Wan Asyraf Wan Zaidi, Khairul Azmi Abd Kadir, Antonio Arauz, Fernando Gongora, Ariunaa Jambaldorj, Ganbaatar Xxx, Zarni Myint Shwe, Win Min Thit, Anna Ranta, Teddy Wu, Erwin E. Rayo, Mayowa Owolabi, Akintomiwa Makanjuola, Saima Ahmad, Mohammad Wasay, Umair Rashid, Ricardo Mernes, Osvaldo Paniagua, Marla Gallo, Manuel Moquillaza, Maria Epifania Collantes, Manuel M. Mariano, Adam Kobayashi, Rafael Rodriguez-Mercado, Rodolfo Alcedo Guardia, Yahia Imam, Ayman Zakaria Ahmed, Adel Alhazzani, Hosam M. Al-Jehani, Wickly Lee, Kamil Zeleňák, Andrej Klepanec, Georgi Krastev, Senta Frol, Naeem Brey, Anastasia Rossouw, Prasad De Silva, Harsha Gunasekera, Udaya Ranawaka, Haytham Osman, Sarah M. El-Sadig, Nijasri C. Suwanwela, Wasan Akarathanawat, Jarturon Tantivatana, Nadia Hammami, Samia Ben Sassi, Atilla Ozcan Ozdemir, Semih Giray, Dmytro Lebedynets, Stanislav Konotopchik, Seby John, Syed Irteza Hussain, Robin Novakovic-White, Atilla Ozcan Ozdemir, Semih Giray, Gillian L. Gordon Perue, Ryna Then, Claudio Berrutti, Roberto Crosa, Huy Thang Nguyen, Huynh Vu Le, Tran Thanh Vu

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1208-1220
Number of pages	13
Journal	Circulation
Volume	147
Issue number	16
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.122.063366
State	Published - Apr 18 2023

Keywords

health services accessibility
healthcare disparities
public health
social determinants of health
stroke
surveys and questionnaires
thrombectomy

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

Access to Document

10.1161/CIRCULATIONAHA.122.063366

Cite this

Asif, K. S., Otite, F. O., Desai, S. M., Herial, N., Inoa, V., Al-Mufti, F., Jadhav, A. P., Dmytriw, A. A., Castonguay, A., Khandelwal, P., Potter-Vig, J., Szeder, V., Kulman, T., Urrutia, V., Masoud, H., Toth, G., Limaye, K., Aroor, S., Brinjikji, W., ... Vu, T. T. (2023). Mechanical Thrombectomy Global Access for Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study. Circulation, 147(16), 1208-1220. https://doi.org/10.1161/CIRCULATIONAHA.122.063366

Asif, KS, Otite, FO, Desai, SM, Herial, N, Inoa, V, Al-Mufti, F, Jadhav, AP, Dmytriw, AA, Castonguay, A, Khandelwal, P, Potter-Vig, J, Szeder, V, Kulman, T, Urrutia, V, Masoud, H, Toth, G, Limaye, K, Aroor, S, Brinjikji, W, Rai, A, Pandian, J, Gebreyohanns, M, Leung, T, Mansour, O, Demchuk, AM, Huded, V, Martins, S, Zaidat, O, Huo, X, Campbell, B, Sylaja, PN, Miao, Z, Saver, J, Ortega-Gutierrez, S, Yavagal, DR, Cirio, JJ, Lylyk, P, Ferrario, A, Plaghos, LL, Arroyo, J, Yan, B, Chandra, R, Ibrahim, WH, Alnidawi, F, Islam, SS, Shahidullah, M, Saavedra, VV, Alverne, FJM, Magalhaes, P, Silva, GS, Sirakov, S, Kalpachki, R, Alioski, N, Lamou, EGB, Shankar, J, Stotts, G, Rowe, D, Gayle, F, De Souza, R, Ramos, C, Garcãa, A, Ali, A, Sandy, S, Lavados, PM, Rivera, R, Guzmán, TFÁ, Villarraga, A, Estrada, C, Pabon, B, Krajina, A, Tomek, A, Adebayo, PB, Abdo, G, Maldonado S, N, Hassan, F, Khedr, EM, Khinikadze, M, Nadareishvili, Z, Tsiskaridze, A, Syrmos, N, Mitsias, P, Das, B, Roy, J, Gupta, V, Gupta, V, Khurana, D, Karapurkar, A, Stivastava, MVP, Alurkar, A, Sharma, A, Lahoti, S, Kumar, R, Kuruttukulam, GV, Sani, AF, Sari, IM, Khassaf, M, Majid Nassir, T, Sakai, N, Yamagami, H, Dababneh, H, Aladham, FA, Berdikhojayev, M, Medukhanova, S, Kikano, R, Alaraj, A, Ahdab, R, Zaidi, WAW, Kadir, KAA, Arauz, A, Gongora, F, Jambaldorj, A, Xxx, G, Shwe, ZM, Thit, WM, Ranta, A, Wu, T, Rayo, EE, Owolabi, M, Makanjuola, A, Ahmad, S, Wasay, M, Rashid, U, Mernes, R, Paniagua, O, Gallo, M, Moquillaza, M, Collantes, ME, Mariano, MM, Kobayashi, A, Rodriguez-Mercado, R, Guardia, RA, Imam, Y, Ahmed, AZ, Alhazzani, A, Al-Jehani, HM, Lee, W, Zeleňák, K, Klepanec, A, Krastev, G, Frol, S, Brey, N, Rossouw, A, De Silva, P, Gunasekera, H, Ranawaka, U, Osman, H, El-Sadig, SM, Suwanwela, NC, Akarathanawat, W, Tantivatana, J, Hammami, N, Sassi, SB, Ozdemir, AO, Giray, S, Lebedynets, D, Konotopchik, S, John, S, Hussain, SI, Novakovic-White, R, Ozdemir, AO, Giray, S, Gordon Perue, GL, Then, R, Berrutti, C, Crosa, R, Nguyen, HT, Le, HV & Vu, TT 2023, 'Mechanical Thrombectomy Global Access for Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study', Circulation, vol. 147, no. 16, pp. 1208-1220. https://doi.org/10.1161/CIRCULATIONAHA.122.063366

@article{ee645035596f438fa70645ff2fd54e8e,

title = "Mechanical Thrombectomy Global Access for Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study",

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.",

keywords = "health services accessibility, healthcare disparities, public health, social determinants of health, stroke, surveys and questionnaires, thrombectomy",

author = "Asif, {Kaiz S.} and Otite, {Fadar O.} and Desai, {Shashvat M.} and Nabeel Herial and Violiza Inoa and Fawaz Al-Mufti and Jadhav, {Ashutosh P.} and Dmytriw, {Adam A.} and Alicia Castonguay and Priyank Khandelwal and Jennifer Potter-Vig and Viktor Szeder and Tanzila Kulman and Victor Urrutia and Hesham Masoud and Gabor Toth and Kaustubh Limaye and Sushanth Aroor and Waleed Brinjikji and Ansaar Rai and Jeyaraj Pandian and Mehari Gebreyohanns and Thomas Leung and Ossama Mansour and Demchuk, {Andrew M.} and Vikram Huded and Sheila Martins and Osama Zaidat and Xiaochuan Huo and Bruce Campbell and Sylaja, {P. N.} and Zhongrong Miao and Jeffrey Saver and Santiago Ortega-Gutierrez and Yavagal, {Dileep R.} and Cirio, {Juan Jose} and Pedro Lylyk and Angel Ferrario and Plaghos, {Luis Lemme} and Jos{\'e} Arroyo and Bernard Yan and Ronil Chandra and Ibrahim, {Wael Hamed} and Firas Alnidawi and Islam, {Sirajee Shafiqul} and Mohammad Shahidullah and Saavedra, {V{\'i}ctor Villarroel} and Alverne, {Francisco Jos{\~a} Mont} and Pedro Magalhaes and Silva, {Gisele Sampaio} and Stanimir Sirakov and Rosen Kalpachki and Nurfet Alioski and Lamou, {Eric Gueumekane Bila} and Jai Shankar and Grant Stotts and Daidre Rowe and Francene Gayle and {De Souza}, Romnesh and Cristina Ramos and Amaury Garc{\~a}a and Amza Ali and Sherry Sandy and Lavados, {Pablo M.} and Rodrigo Rivera and Guzm{\'a}n, {Tony Fabi{\'a}n {\'A}lvarez} and Alejandro Villarraga and Carolina Estrada and Boris Pabon and Antonin Krajina and Ale{\v s} Tomek and Adebayo, {Philip B.} and German Abdo and {Maldonado S}, Nelson and Farouk Hassan and Khedr, {Eman M.} and Mirza Khinikadze and Zurab Nadareishvili and Alexander Tsiskaridze and Nikolaos Syrmos and Panayiotis Mitsias and Biplab Das and Jayanta Roy and Vivek Gupta and Vipul Gupta and Dheeraj Khurana and Anil Karapurkar and Stivastava, {M. V.Padma} and Anand Alurkar and Arvind Sharma and Satish Lahoti and Rahul Kumar and Kuruttukulam, {Gigy Varkey} and Sani, {Achmad Firdaus} and Sari, {Ita Muharram} and Mustafa Khassaf and {Majid Nassir}, Temeem and Nobuyuki Sakai and Hiroshi Yamagami and Haitham Dababneh and Aladham, {Farid A.} and Mynzhylky Berdikhojayev and Sabina Medukhanova and Raghid Kikano and Ali Alaraj and Rechdi Ahdab and Zaidi, {Wan Asyraf Wan} and Kadir, {Khairul Azmi Abd} and Antonio Arauz and Fernando Gongora and Ariunaa Jambaldorj and Ganbaatar Xxx and Shwe, {Zarni Myint} and Thit, {Win Min} and Anna Ranta and Teddy Wu and Rayo, {Erwin E.} and Mayowa Owolabi and Akintomiwa Makanjuola and Saima Ahmad and Mohammad Wasay and Umair Rashid and Ricardo Mernes and Osvaldo Paniagua and Marla Gallo and Manuel Moquillaza and Collantes, {Maria Epifania} and Mariano, {Manuel M.} and Adam Kobayashi and Rafael Rodriguez-Mercado and Guardia, {Rodolfo Alcedo} and Yahia Imam and Ahmed, {Ayman Zakaria} and Adel Alhazzani and Al-Jehani, {Hosam M.} and Wickly Lee and Kamil Zele{\v n}{\'a}k and Andrej Klepanec and Georgi Krastev and Senta Frol and Naeem Brey and Anastasia Rossouw and {De Silva}, Prasad and Harsha Gunasekera and Udaya Ranawaka and Haytham Osman and El-Sadig, {Sarah M.} and Suwanwela, {Nijasri C.} and Wasan Akarathanawat and Jarturon Tantivatana and Nadia Hammami and Sassi, {Samia Ben} and Ozdemir, {Atilla Ozcan} and Semih Giray and Dmytro Lebedynets and Stanislav Konotopchik and Seby John and Hussain, {Syed Irteza} and Robin Novakovic-White and Ozdemir, {Atilla Ozcan} and Semih Giray and {Gordon Perue}, {Gillian L.} and Ryna Then and Claudio Berrutti and Roberto Crosa and Nguyen, {Huy Thang} and Le, {Huynh Vu} and Vu, {Tran Thanh}",

note = "Publisher Copyright: {\textcopyright} 2023 American Heart Association, Inc.",

year = "2023",

month = apr,

day = "18",

doi = "10.1161/CIRCULATIONAHA.122.063366",

language = "English (US)",

volume = "147",

pages = "1208--1220",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams and Wilkins",

number = "16",

}

TY - JOUR

T1 - Mechanical Thrombectomy Global Access for Stroke (MT-GLASS)

T2 - A Mission Thrombectomy (MT-2020 Plus) Study

AU - Asif, Kaiz S.

AU - Otite, Fadar O.

AU - Desai, Shashvat M.

AU - Herial, Nabeel

AU - Inoa, Violiza

AU - Al-Mufti, Fawaz

AU - Jadhav, Ashutosh P.

AU - Dmytriw, Adam A.

AU - Castonguay, Alicia

AU - Khandelwal, Priyank

AU - Potter-Vig, Jennifer

AU - Szeder, Viktor

AU - Kulman, Tanzila

AU - Urrutia, Victor

AU - Masoud, Hesham

AU - Toth, Gabor

AU - Limaye, Kaustubh

AU - Aroor, Sushanth

AU - Brinjikji, Waleed

AU - Rai, Ansaar

AU - Pandian, Jeyaraj

AU - Gebreyohanns, Mehari

AU - Leung, Thomas

AU - Mansour, Ossama

AU - Demchuk, Andrew M.

AU - Huded, Vikram

AU - Martins, Sheila

AU - Zaidat, Osama

AU - Huo, Xiaochuan

AU - Campbell, Bruce

AU - Sylaja, P. N.

AU - Miao, Zhongrong

AU - Saver, Jeffrey

AU - Ortega-Gutierrez, Santiago

AU - Yavagal, Dileep R.

AU - Cirio, Juan Jose

AU - Lylyk, Pedro

AU - Ferrario, Angel

AU - Plaghos, Luis Lemme

AU - Arroyo, José

AU - Yan, Bernard

AU - Chandra, Ronil

AU - Ibrahim, Wael Hamed

AU - Alnidawi, Firas

AU - Islam, Sirajee Shafiqul

AU - Shahidullah, Mohammad

AU - Saavedra, Víctor Villarroel

AU - Alverne, Francisco Josã Mont

AU - Magalhaes, Pedro

AU - Silva, Gisele Sampaio

AU - Sirakov, Stanimir

AU - Kalpachki, Rosen

AU - Alioski, Nurfet

AU - Lamou, Eric Gueumekane Bila

AU - Shankar, Jai

AU - Stotts, Grant

AU - Rowe, Daidre

AU - Gayle, Francene

AU - De Souza, Romnesh

AU - Ramos, Cristina

AU - Garcãa, Amaury

AU - Ali, Amza

AU - Sandy, Sherry

AU - Lavados, Pablo M.

AU - Rivera, Rodrigo

AU - Guzmán, Tony Fabián Álvarez

AU - Villarraga, Alejandro

AU - Estrada, Carolina

AU - Pabon, Boris

AU - Krajina, Antonin

AU - Tomek, Aleš

AU - Adebayo, Philip B.

AU - Abdo, German

AU - Maldonado S, Nelson

AU - Hassan, Farouk

AU - Khedr, Eman M.

AU - Khinikadze, Mirza

AU - Nadareishvili, Zurab

AU - Tsiskaridze, Alexander

AU - Syrmos, Nikolaos

AU - Mitsias, Panayiotis

AU - Das, Biplab

AU - Roy, Jayanta

AU - Gupta, Vivek

AU - Gupta, Vipul

AU - Khurana, Dheeraj

AU - Karapurkar, Anil

AU - Stivastava, M. V.Padma

AU - Alurkar, Anand

AU - Sharma, Arvind

AU - Lahoti, Satish

AU - Kumar, Rahul

AU - Kuruttukulam, Gigy Varkey

AU - Sani, Achmad Firdaus

AU - Sari, Ita Muharram

AU - Khassaf, Mustafa

AU - Majid Nassir, Temeem

AU - Sakai, Nobuyuki

AU - Yamagami, Hiroshi

AU - Dababneh, Haitham

AU - Aladham, Farid A.

AU - Berdikhojayev, Mynzhylky

AU - Medukhanova, Sabina

AU - Kikano, Raghid

AU - Alaraj, Ali

AU - Ahdab, Rechdi

AU - Zaidi, Wan Asyraf Wan

AU - Kadir, Khairul Azmi Abd

AU - Arauz, Antonio

AU - Gongora, Fernando

AU - Jambaldorj, Ariunaa

AU - Xxx, Ganbaatar

AU - Shwe, Zarni Myint

AU - Thit, Win Min

AU - Ranta, Anna

AU - Wu, Teddy

AU - Rayo, Erwin E.

AU - Owolabi, Mayowa

AU - Makanjuola, Akintomiwa

AU - Ahmad, Saima

AU - Wasay, Mohammad

AU - Rashid, Umair

AU - Mernes, Ricardo

AU - Paniagua, Osvaldo

AU - Gallo, Marla

AU - Moquillaza, Manuel

AU - Collantes, Maria Epifania

AU - Mariano, Manuel M.

AU - Kobayashi, Adam

AU - Rodriguez-Mercado, Rafael

AU - Guardia, Rodolfo Alcedo

AU - Imam, Yahia

AU - Ahmed, Ayman Zakaria

AU - Alhazzani, Adel

AU - Al-Jehani, Hosam M.

AU - Lee, Wickly

AU - Zeleňák, Kamil

AU - Klepanec, Andrej

AU - Krastev, Georgi

AU - Frol, Senta

AU - Brey, Naeem

AU - Rossouw, Anastasia

AU - De Silva, Prasad

AU - Gunasekera, Harsha

AU - Ranawaka, Udaya

AU - Osman, Haytham

AU - El-Sadig, Sarah M.

AU - Suwanwela, Nijasri C.

AU - Akarathanawat, Wasan

AU - Tantivatana, Jarturon

AU - Hammami, Nadia

AU - Sassi, Samia Ben

AU - Ozdemir, Atilla Ozcan

AU - Giray, Semih

AU - Lebedynets, Dmytro

AU - Konotopchik, Stanislav

AU - John, Seby

AU - Hussain, Syed Irteza

AU - Novakovic-White, Robin

AU - Ozdemir, Atilla Ozcan

AU - Giray, Semih

AU - Gordon Perue, Gillian L.

AU - Then, Ryna

AU - Berrutti, Claudio

AU - Crosa, Roberto

AU - Nguyen, Huy Thang

AU - Le, Huynh Vu

AU - Vu, Tran Thanh

PY - 2023/4/18

Y1 - 2023/4/18

N2 - 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.

AB - 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.

KW - health services accessibility

KW - healthcare disparities

KW - public health

KW - social determinants of health

KW - stroke

KW - surveys and questionnaires

KW - thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85152635440&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85152635440&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.122.063366

DO - 10.1161/CIRCULATIONAHA.122.063366

M3 - Article

C2 - 36883458

AN - SCOPUS:85152635440

SN - 0009-7322

VL - 147

SP - 1208

EP - 1220

JO - Circulation

JF - Circulation

IS - 16

ER -

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

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