Citations 2
Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study
Asif, Kaiz , Otite, Fadar Oliver , Desai, Shashvat M. , Herial, Nabeel , Inoa, Violiza , Al‐Mufti, Fawaz , Dmytriw, Adam A. , Castonguay, Alicia C. , Khandelwal, Priyank , Potter‐Vig, Jennifer , Szeder, Viktor , Kulman, Tanzila, Masoud, Hesham , Tóth, Gábor , Limaye, Kaustubh , Aroor, Sushanth , Brinjikji, Waleed , Rai, Ansaar , Gebreyohanns, Mehari , Leung, Thomas , Mansour, Malek , Huded, Vikram , Zaidat, Osama O. , Sylaja, PN , Yavagal, Dileep R. , Cirio, Juan , Lylyk, Pedro , Ferrario, Ángel, Plaghos, Luis Lemme, Ibrahim, Wael Hamed, Alnidawi, Firas , Islam, Sirajee Shafiqul, Shahidullah, Mohammad, Saavedra, Víctor Villarroel, Alverne, Francisco Josà Mont’, Magalhães, Pedro , Sirakov, Stanimir , Kalpachki, Rosen, Alioski, Nurfet, Lamou, Eric Gueumekane Bila , Rowe, Daidre, Gayle, Francene , Souza, Romnesh de, Ramos, Cristina , GarcÃa, Amaury, Ali, Amza , Sandy, Sherry , Guzman, Tony Fabian Alvarez, Villarraga, Alejandro, Estrada, Carolina, Pabón, B , Adebayo, Philip , ABDO, GERMAN, S, Nelson Maldonado, Khinikadze, Mirza, Tsiskaridze, Alexander , Syrmos, Νikolaos , Mitsias, Panayiotis , Das, Biplab , Gupta, Vipul , Karapurkar, Anil, Stivastava, M.V.Padma, Alurkar, Anand, Sharma, Arvind , Lahoti, Satish, Kuruttukulam, Gigy , Sari, Ita Muharram , Khassaf, Mustafa Saleem, Nassir, Temeem Majid, Yamagami, Hiroshi , Dababneh, Haitham, Aladham, Farid A., Berdikhojayev, Mynzhylky , Medukhanova, Sabina , Kikano, Raghid, Alaraj, Ali , Ahdab, Rechdi , Zaidi, Wan Asyraf Wan , Kadir, Khairul Azmi Abd, Gongora, Fernando, Jambaldorj, Ariunaa , XXX, Ganbaatar, Shwe, Zarni Myint, Thit, Win Min , RAYO, ERWIN E., Makanjuola, Akintomiwa , Rashid, Umair, Mernes, Ricardo, Paniagua, Osvaldo, GALLO, MARLA, Moquillaza, Manuel, Collantes, Maria Epifania , Mariano, Manuel, Kobayashi, Adam , Rodríguez‐Mercado, Rafael, Guardia, Rodolfo Alcedo, Imam, Yahia , Ahmed, Ayman Z., Al-Jehani, Hosam , Lee, Wickly, Klepanec, Andrej , Brey, Naeem , Rossouw, Anastasia, Silva, Prasad De, Gunasekera, Harsha, Ranawaka, Udaya K. , Osman, Haytham , El-Sadig, Sarah , Suwanwela, Nijasri C., Akarathanawat, Wasan, Tantivatana, Jarturon , Hammami, Nadia, Giray, Semih , Lebedynets, Dmytro , Konotopchik, Stanislav, John, Seby , Hussain, Syed , Novakovic-White, Robin, Perue, Gillian L Gordon, Then, Ryna , Berrutti, Claudio, Crosa, Roberto , Nguyen, Huy Thang, Le, Huynh Vu, vu, Tran thanh, Asif, Kaiz S , Otite, Fadar O , Jadhav, Ashutosh P , Dmytriw, Adam A , Castonguay, Alicia , Khandelwal, Priyank , Szeder, Viktor , Urrutia, Victor C , Masoud, Hesham , Toth, Gabor , Limaye, Kaustubh , Brinjikji, Waleed , Rai, Ansaar , Pandian, Jeyaraj , Leung, Thomas , Mansour, Ossama , Demchuk, Andrew M , Martins, Sheila , Zaidat, Osama O , Huo, Xiaochuan , Campbell, Bruce , Miao, Zhongrong , Saver, Jeffrey , Ortega-Gutierrez, Santiago , Yavagal, Dileep R , Crosa, Roberto , Alaraj, Ali , Al-Mufti, Fawaz , Jadhav, Ashutosh P. , Urrutia, Victor , Pandian, Jeyaraj , Demchuk, Andrew M. , Saver, Jeffrey L. , Arroyo, José, Yan, Bernard , Chandra, Ronil Vikesh , Shahidullah, Mohammad, Alverne, F Mont, Silva, Gisele Sampaio , Shankar, Jai , Stotts, Grant , Ramos, Cristina, Lavados, Pablo M. , Rivera, Rodrigo , Krajina, Antonı́n , Tomek, Aleš , Hassan, Farouk , Khedr, Eman M. , Nadareishvili, Zurab , Roy, Jayanta , Gupta, Vivek , Khurana, Dheeraj , Kumar, Rahul Kewal , Sani, Achmad Firdaus , Sakai, Nobuyuki , Aladham, Farid, Kikano, Raghid , Araúz, Antonio , Góngora‐Rivera, Fernando , Shwe, Zarni Myint, Ranta, Annemarei , Wu, Teddy Y , Owolabi, Mayowa , Ahmad, Saima , Wasay, Mohammad , Alhazzani, Adel Ali , Zeleňák, Kamil , Krastev, Georgi , Frol, Senta , Hammami, Nadia, Sassi, Samia Ben , Özdemi̇r, Atilla Özcan , Конотопчик, С. В., Perue, Gillian Gordon
Circulation | March 8, 2023 | Volume: 147 | Issue: 16 | Pages: 1208-1220
10.1161/circulationaha.122.063366
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.
A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization
Mead, Gillian , Yperzeele, Laetitia , Wu, Simiao , Cheyne, Joshua , Wahab, Kolawole , Urrutia, Victor , Sylaja, PN , Steiner, Thorsten , Liebeskind, David S, Liebeskind, David S. , Mead, Gillian E , Yperzeele, Laetitia , Wu, Simiao , Urrutia, Victor C , Sylaja, P N , Steiner, Thorsten , Rabinstein, Alejandro A , Liebeskind, David S. , Sposato, Luciano A. , Silva, Gisele Sampaio , Kutlubaev, Mansur Amirovich , Sharma, Vijay K, Hill, Kelvin M , Rabinstein, Alejandro A.
International Journal of Stroke | February 1, 2023 | Volume: 18 | Issue: 5 | Pages: 499-531
Background: There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. Aims: To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). Summary of review: Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. Conclusion: The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.