Challenges to Widespread Implementation of Stroke Thrombectomy

Author:

Ospel Johanna Maria12ORCID,Diprose William K.2,Ganesh Aravind2,Martins Sheila3,Nguyen Thanh4,Psychogios Marios5,Mansour Ossama6,Al-Ajlan Fahad7,Yang Pengfei8,Pandian Jeyaraj9,Gopinathan Anil10,Sandset Else Charlotte11,Kennedy James12,Volders David13,Fahed Robert14,Tjoumakaris Stavropoula15,Bhogal Pervinder16,Kurz Martin17,Yavagal Dileep18,Inoa Violiza19,Hill Michael D.12,Goyal Mayank12ORCID

Affiliation:

1. Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

2. Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

3. Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S.M.).

4. Departments of Radiology and Neurology, Boston Medical Center, MA (T.N.).

5. Department of Neuroradiology, University Hospital Basel, Switzerland (M.P.).

6. Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt (O.M.).

7. Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (F.A.-A.).

8. Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (P.Y.).

9. Department of Neurology, Christian Medical College and Hospital, Vellore, India (J.P.).

10. Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore (A. Gopinathan).

11. Department of Neurology, Oslo University Hospital, Ullevål, Norway (E.C.S.).

12. Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom (J.K.).

13. Department of Radiology, Dalhousie University, Halifax, Canada (D.V.).

14. Division Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (R.F.).

15. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.T.).

16. Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.).

17. Department of Neurology, Stavanger University Hospital, Norway (M.K.).

18. Department of Neurology, University of Miami Miller School of Medicine, FL (D.Y.).

19. Department of Neurology, University of Tennessee Health Science Center, Memphis (V.I.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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