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.
Time From Symptoms to Carotid Endarterectomy or Stenting and Perioperative Risk
Hopkins, L. Nelson , Altafullah, Irfan, Wechsler, Lawrence R. , Gonzales, Nicole R. , Voeks, Jenifer H. , Howard, George , Brott, Thomas G. , Stotts, Grant, Meschia, James F. , Stotts, Grant , Howard, George
Stroke | October 23, 2015 | Volume: 46 | Issue: 12 | Pages: 3540-3542
Background and Purpose— Prior meta-analysis showed that carotid endarterectomy benefits decline with increasing surgical delay following symptoms. For symptomatic patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), we assessed if differences in time between symptoms and carotid endarterectomy or carotid artery stenting are associated with differences in risk of periprocedural stroke or death. Methods— We analyzed the 1180 symptomatic patients in CREST who received their assigned procedure and had clearly defined timing of symptoms. Patients were classified into 3 groups based on time from symptoms to procedure: <15, 15 to 60, and >60 days. Results— For carotid endarterectomy, risk of periprocedural stroke or death was not significantly different for the 2 later time periods relative to the earliest time period (hazard ratio, 0.74; 95% confidence interval, 0.22–2.49 for 15–60 days and hazard ratio, 0.91; 95% confidence interval, 0.25–3.33 for >60 days; P =0.89). For carotid artery stenting, risk of periprocedural stroke or death was also not significantly different for later time periods relative to the earliest time period (hazard ratio, 1.12; 95% confidence interval, 0.53–2.40 for 15–60 days and hazard ratio, 1.15; 95% confidence interval, 0.48–2.75 for >60 days; P =0.93). Conclusions— Time from symptoms to carotid endarterectomy or carotid artery stenting did not alter periprocedural safety, supporting early revascularization regardless of modality. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00004732.