Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy

Sushanth R Aroor; Cynthia B Zevallos; Kaiz S Asif; Nishita Singh; Jennifer Potter-Vig; Aaron Rodriguez-Calienes; Bijoy K Menon; Aravind Ganesh; Jeffrey L Saver; Hooman Kamel; Anne W Alexandrov; Edward C Jauch; Zhongrong Miao; Xiaochuan Huo; Pankajavalli Ramakrishnan; Shashvat M Desai; Kaustubh Limaye; Mohammad El-Ghanem; Gabor Toth; Chetan V Rao; Hesham E Masoud; Qingliang Tony Wang; Nabeel A Herial; Kunakorn Atchaneeyasakul; Viktor Szeder; Krishna Amuluru; Victor C Urrutia; Fawaz Al-Mufti; Dileep R Yavagal; Santiago Ortega-Gutierrez

doi:10.1161/STROKEAHA.124.047805

Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy

Stroke. 2024 Oct 25. doi: 10.1161/STROKEAHA.124.047805. Online ahead of print.

Authors

Sushanth R Aroor^#¹, Cynthia B Zevallos^#², Kaiz S Asif³, Nishita Singh⁴, Jennifer Potter-Vig⁵, Aaron Rodriguez-Calienes⁶, Bijoy K Menon⁷, Aravind Ganesh⁷, Jeffrey L Saver⁸, Hooman Kamel⁹, Anne W Alexandrov¹⁰, Edward C Jauch¹¹, Zhongrong Miao¹², Xiaochuan Huo¹³, Pankajavalli Ramakrishnan¹⁴, Shashvat M Desai¹⁵, Kaustubh Limaye¹⁶, Mohammad El-Ghanem¹⁷, Gabor Toth¹⁸, Chetan V Rao¹⁹, Hesham E Masoud²⁰, Qingliang Tony Wang²¹, Nabeel A Herial²², Kunakorn Atchaneeyasakul²³, Viktor Szeder⁸, Krishna Amuluru²⁴, Victor C Urrutia²⁵, Fawaz Al-Mufti²⁶, Dileep R Yavagal²⁷, Santiago Ortega-Gutierrez²

Affiliations

¹ University of Texas Health Science Center, Houston (S.R.A.).
² University of Iowa Hospitals and Clinics, Iowa City (C.B.Z., S.O.-G.).
³ Ascension Health, Chicago, IL; University of Illinois Chicago (K.S.A.).
⁴ Rady Faculty of Health Sciences, Division of Neurology, University of Manitoba, Winnipeg, Canada (N.S.).
⁵ University of Illinois Springfield, IL (J.P.-V.).
⁶ Universidad Cientifica del Sur, Lima, Peru (A.R.-C.).
⁷ University of Calgary, Alberta, Canada (B.K.M., A.G.).
⁸ University of California Los Angeles (J.L.S., V.S.).
⁹ Weill Cornell Medicine, New York City, NY (H.K.).
¹⁰ University of Tennessee Health Science Center, Memphis (A.W.A.).
¹¹ University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville (E.C.J.).
¹² Beijing Tiantan Hospital, Capital Medical University, China. (Z.M.).
¹³ Beijing Anzhen Hospital, Capital Medical University, China. (X.H.).
¹⁴ Riverside Regional Medical Center, Newport, VA (P.R.).
¹⁵ HonorHealth, Scottsdale, AZ (S.M.D.).
¹⁶ Indiana University School of Medicine, Indianapolis (K.L.).
¹⁷ Hospital Corporation of America Houston Northwest and University of Houston, TX (M.E.-G.).
¹⁸ Cleveland Clinic, OH (G.T.).
¹⁹ Baylor College of Medicine, Houston, TX (C.V.R.).
²⁰ State University of New York Upstate University, Syracuse (H.E.M.).
²¹ State University of New York Downstate Health Sciences University, Brooklyn (Q.T.W.).
²² Thomas Jefferson University, Philadelphia, PA (N.A.H.).
²³ Virginia Mason Medical Center, Seattle, WA (K. Atchaneeyasakul).
²⁴ Goodman Campbell Brain and Spine, Indianapolis, IN (K. Amuluru).
²⁵ Johns Hopkins University School of Medicine, Baltimore, MD (V.C.U.).
²⁶ Westchester Medical Center at New York Medical College, Valhalla (F.A.-M.).
²⁷ University of Miami Miller School of Medicine, FL (D.R.Y.).

^# Contributed equally.

PMID: 39450508
DOI: 10.1161/STROKEAHA.124.047805

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.

Keywords: Delphi technique; emergency medical services; ischemic stroke; stroke; thrombectomy.