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. 2023 Sep;8(3):618-628.
doi: 10.1177/23969873231186042. Epub 2023 Jul 11.

Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

Diana Aguiar de Sousa  1 , Arlene Wilkie  2 , Bo Norrving  3 , Chris Macey  4 , Claudio Bassetti  5 , Cristina Tiu  6 , Greg Roth  7 , Grethe Lunde  2 , Hanne Christensen  8 , Jens Fiehler  9 , Francesca Romana Pezzella  10 , Martin Dichgans  11 , Melinda B Roaldsen  12 , Peter Kelly  13 , Robert Mikulik  14 , Simona Sacco  15 , Valeria Caso  16 , Urs Fischer  17 ; Steering Committee for the Implementation of the Stroke Action Plan in Europe
Collaborators, Affiliations

Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020

Diana Aguiar de Sousa et al. Eur Stroke J. 2023 Sep.

Abstract

Introduction: We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020.

Patients and methods: We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively.

Results: The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90-4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63-26.43) per 100,000 and 17.14% (95% CI: 12.98-21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96-9.77) per 100,000 and 6.91% (95% CI: 5.15-8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016.

Conclusion: Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.

Keywords: Europe; acute stroke treatment; endovascular treatment; health care resources; intravenous thrombolysis; stroke care implementation; stroke unit.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Estimates for the annual rate of patients receiving intravenous thrombolysis per 100 000 inhabitants in 42 countries from the European region in 2019.
Figure 2.
Figure 2.
Estimates for the annual proportion of incident ischaemic strokes receiving intravenous thrombolysis in 42 countries from the European region in 2019.
Figure 3.
Figure 3.
Estimates for the annual rate of patients receiving endovascular treatment per 100,000 inhabitants in 42 countries from the European region in 2019.
Figure 4.
Figure 4.
Estimates for the annual proportion of incident ischaemic strokes receiving endovascular treatment in 42 countries from the European region in 2019.
See this image and copyright information in PMC

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