Abstract Details

Title Access to Mechanical Thrombectomy for Large Vessel Occlusion Stroke: An MT2020+ Report on Global Disparities

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Cerebrovascular Disease: Diagnosis, Prediction, and Population Health (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background MT is a highly effective treatment for large vessel occlusion (LVO) stroke. At a global level, disparities in MT access have not been studied.

Objective

To study factors affecting mechanical thrombectomy (MT) access in a global cohort of countries and estimate the number of MT operators and centers needed country-wise to meet the gap.

Design/Methods

An electronic survey was distributed to 75 MT2020+ Regional Committees. MT access was defined as the proportion of estimated LVO patients receiving MT. Based on an assumption of an optimal MT volume per operator of 50 and an optimal MT volume per center of 150, we defined the following indices: Optimal MT operator index [(One MT operator/Optimal number of LVO) x 100= 1/50 x 100= 2] and optimal MT center index [(One MT center/Optimal number of LVO) x 100 = 1/150 x 100 = 0.67]. The current MT center and operator indices were then calculated for each country as [(Current number of MT operator or center/Optimal number of LVO) x 100].

Results Complete responses (702) from 59 countries were analyzed. The median MT access was 2.76 % (IQR 0.66 to 14.70). There were significant differences in MT access amongst countries grouped by their per capita gross national income (GNI). On multivariate regression models, MT access correlated with per capita GNI of the country (??: -1.97, 95%, CI -2.70 to -1.24, P <0.001), reimbursement (?? 0.69, CI 0.19 to 1.19, P = 0.008), MT operator index (??: 0.85%, CI 0.30 to 1.39, P = 0.003) and MT center index (??: 2.01, CI - 0.96 to 3.06, P <0.001). China and India have the largest absolute MT center and MT operator gap.

Conclusions MT access is low worldwide with vast disparities amongst countries. Determinants of access are the country’s per capita GNI, availability of reimbursement, and their MT operator and center indices.

Authors/Disclosures
Kaiz S. Asif, MD (Ascension Health) PRESENTER	Dr. Asif has nothing to disclose.
Nabeel Herial, MD, MPH, FAAN (N/A)	Dr. Herial has nothing to disclose.
Fadar O. Otite, MD (SUNY Upstate Medical University)	Dr. Otite has nothing to disclose.
Shashvat Desai, MD (University of Pittsburgh Medical Center)	Dr. Desai has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.
Adam Dmytriw (Massachusetts General Hospital)	No disclosure on file
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .
Priyank Khandelwal, MD	Dr. Khandelwal has nothing to disclose.
Violiza A. Inoa, MD	No disclosure on file
	No disclosure on file
Viktor Szeder, MD, PhD	Dr. Szeder has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Szeder has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Carroll, Kelly, Trotter, Franzen, McBride & Peabody LLP. Dr. Szeder has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Peabody and Buccini LLP.
Tanzila Kulman, MD	No disclosure on file
Gabor Toth, MD (Cleveland Clinic Foundation)	Dr. Toth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Toth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic.
Alicia C. Castonguay, PhD	Dr. Castonguay has nothing to disclose.
	No disclosure on file
Victor C. Urrutia, MD (Johns Hopkins University School of Medicine)	Dr. Urrutia has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech, Inc. The institution of Dr. Urrutia has received research support from Genentech, Inc. The institution of Dr. Urrutia has received research support from Genentech, Inc. Dr. Urrutia has received personal compensation in the range of $5,000-$9,999 for serving as a Medical Director of CME course with PeerView.
Kaustubh S. Limaye, MD (Indiana University School of Medicine)	Dr. Limaye has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scientia Vascular.
Hesham Masoud, MD (Department of Neurology)	Dr. Masoud has nothing to disclose.
Syed F. Zaidi, MD (ProMedica Stroke Network)	Dr. Zaidi has nothing to disclose.
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.