NYMC Faculty Publications
Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy
Author Type(s)
Faculty
DOI
10.1161/STROKEAHA.124.047805
Journal Title
Stroke
First Page
158
Last Page
167
Document Type
Article
Publication Date
1-1-2025
Department
Neurology
Keywords
Delphi technique, emergency medical services, ischemic stroke, stroke, thrombectomy
Disciplines
Medicine and Health Sciences
Abstract
BACKGROUND: The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. METHODS: We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. RESULTS: Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. CONCLUSIONS: The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.
Recommended Citation
Aroor, S., Zevallos, C., Asif, K., Singh, N., Potter-Vig, J., Rodriguez-Calienes, A., Menon, B., Ganesh, A., Saver, J., Kamel, H., Alexandrov, A., Jauch, E., Miao, Z., Huo, X., Ramakrishnan, P., Desai, S., Limaye, K., El-Ghanem, M., Toth, G., Rao, C., Masoud, H., Wang, Q., Herial, N., Atchaneeyasakul, K., Szeder, V., Amuluru, K., Urrutia, V., Al-Mufti, F., Yavagal, D., & Ortega-Gutierrez, S. (2025). Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy. Stroke, 56 (1), 158-167. https://doi.org/10.1161/STROKEAHA.124.047805
