NYMC Faculty Publications

Mechanical Thrombectomy Global Access for Stroke (Mt-Glass): A Mission Thrombectomy (Mt-2020 Plus) Study


Kaiz S. Asif, Ascension Health, Chicago, IL (K.S.A.).
Fadar O. Otite, SUNY Upstate Medical University, Syracuse, NY (F.O.O.).
Shashvat M. Desai, HonorHealth Research and Innovation Institute, Scottsdale, AZ (S.M.D.).
Nabeel Herial, Thomas Jefferson University, Philadelphia, PA (N.H.).
Violiza Inoa, Semmes-Murphey Neurologic and Spine Clinic, Memphis, TN (V.I.).
Fawaz Al-Mufti, New York Medical College, Valhalla, NY (F.A.-M.).
Ashutosh P. Jadhav, Barrow Neurological Institute, Phoenix, AZ (A.P.J.).
Adam A. Dmytriw, Massachusetts General Hospital, Boston (A.A.D.).
Alicia Castonguay, University of Toledo, OH (A.C.).
Priyank Khandelwal, Rutgers New Jersey Medical School, Newark (P.K.).
Jennifer Potter-Vig, Society of Vascular and Interventional Neurology/MT2020, University of Illinois, Springfield, IL (J.P.-V.).
Viktor Szeder, University of California, Los Angeles (V.S., J.S.).
Tanzila Kulman, Aultman Hospital, Canton, OH (T.K.).
Victor Urrutia, Johns Hopkins University School of Medicine, Baltimore, MD (V.U.).
Hesham Masoud, State University of New York, Syracuse (H.M.).
Gabor Toth, Cleveland Clinic, OH (G.T.).
Kaustubh Limaye, Indiana University, Bloomington (K.L.).
Sushanth Aroor, Rutgers University, Newark, NJ (S.A.).
Waleed Brinjikji, Mayo Clinic, Rochester, MN (W.B.).
Ansaar Rai, West Virginia University, Morgantown (A.R.).
Jeyaraj Pandian, Christian Medical College, Vellore, India (J.P.).
Mehari Gebreyohanns, University of Texas Southwestern Medical Center, Dallas (M.G.).
Thomas Leung, Prince of Wales Hospital, Randwick, Australia (T.L.).
Ossama Mansour, Alexandria University, Egypt (O.M.).
Andrew M. Demchuk, Calgary Stroke Program, Canada (A.M.D.).
Vikram Huded, NH Institute of Neurosciences, Bengaluru, Karnataka, India (V.H.).
Sheila Martins, University of Rio Grande do Sul, Porto Alegre, Brazil (S.M.).
Osama Zaidat, St Vincent Mercy Medical Center, Toledo, OH (O.Z.).
Xiaochuan Huo, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.H., Z.M.).
Bruce Campbell, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.).
P N. Sylaja, University of Texas Southwestern Medical Center, Dallas (M.G.).
Zhongrong Miao, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.H., Z.M.).

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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.