Challenges to Widespread Implementation of Stroke Thrombectomy

Johanna Maria Ospel^{1

2}, William K Diprose², Aravind Ganesh², Sheila Martins³, Thanh Nguyen⁴, Marios Psychogios⁵, Ossama Mansour⁶, Fahad Al-Ajlan⁷, Pengfei Yang⁸, Jeyaraj Pandian⁹, Anil Gopinathan¹⁰, Else Charlotte Sandset¹¹, James Kennedy¹², David Volders¹³, Robert Fahed¹⁴, Stavropoula Tjoumakaris¹⁵, Pervinder Bhogal¹⁶, Martin Kurz¹⁷, Dileep Yavagal¹⁸, Violiza Inoa¹⁹, Michael D Hill^{1

2}, Mayank Goyal^{1

2}

Affiliations

¹ Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
² Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
³ Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S.M.).
⁴ Departments of Radiology and Neurology, Boston Medical Center, MA (T.N.).
⁵ Department of Neuroradiology, University Hospital Basel, Switzerland (M.P.).
⁶ Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt (O.M.).
⁷ Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (F.A.-A.).
⁸ Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (P.Y.).
⁹ Department of Neurology, Christian Medical College and Hospital, Vellore, India (J.P.).
¹⁰ Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore (A. Gopinathan).
¹¹ Department of Neurology, Oslo University Hospital, Ullevål, Norway (E.C.S.).
¹² Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom (J.K.).
¹³ Department of Radiology, Dalhousie University, Halifax, Canada (D.V.).
¹⁴ Division Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (R.F.).
¹⁵ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.T.).
¹⁶ Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.).
¹⁷ Department of Neurology, Stavanger University Hospital, Norway (M.K.).
¹⁸ Department of Neurology, University of Miami Miller School of Medicine, FL (D.Y.).
¹⁹ Department of Neurology, University of Tennessee Health Science Center, Memphis (V.I.).

PMID: 38979609
DOI: 10.1161/STROKEAHA.124.045889

Review

Challenges to Widespread Implementation of Stroke Thrombectomy

Johanna Maria Ospel et al. Stroke. 2024 Aug.

. 2024 Aug;55(8):2173-2183.

doi: 10.1161/STROKEAHA.124.045889. Epub 2024 Jul 9.

Authors

Affiliations

¹ Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
² Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
³ Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S.M.).
⁴ Departments of Radiology and Neurology, Boston Medical Center, MA (T.N.).
⁵ Department of Neuroradiology, University Hospital Basel, Switzerland (M.P.).
⁶ Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt (O.M.).
⁷ Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (F.A.-A.).
⁸ Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (P.Y.).
⁹ Department of Neurology, Christian Medical College and Hospital, Vellore, India (J.P.).
¹⁰ Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore (A. Gopinathan).
¹¹ Department of Neurology, Oslo University Hospital, Ullevål, Norway (E.C.S.).
¹² Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom (J.K.).
¹³ Department of Radiology, Dalhousie University, Halifax, Canada (D.V.).
¹⁴ Division Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (R.F.).
¹⁵ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.T.).
¹⁶ Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.).
¹⁷ Department of Neurology, Stavanger University Hospital, Norway (M.K.).
¹⁸ Department of Neurology, University of Miami Miller School of Medicine, FL (D.Y.).
¹⁹ Department of Neurology, University of Tennessee Health Science Center, Memphis (V.I.).

PMID: 38979609
DOI: 10.1161/STROKEAHA.124.045889

Abstract

Endovascular treatment (EVT) for acute ischemic stroke is one of the most efficacious and effective treatments in medicine, yet globally, its implementation remains limited. Patterns of EVT underutilization exist in virtually any health care system and range from a complete lack of access to selective undertreatment of certain patient subgroups. In this review, we outline different patterns of EVT underutilization and possible causes. We discuss common challenges and bottlenecks that are encountered by physicians, patients, and other stakeholders when trying to establish and expand EVT services in different scenarios and possible pathways to overcome these challenges. Lastly, we discuss the importance of implementation research studies, strategic partnerships, and advocacy efforts to mitigate EVT underutilization.

Keywords: brain ischemia; ischemic stroke; physicians; stroke; undertreatment.

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Conflict of interest statement

Dr Ospel is a consultant for Nicolab. Dr Goyal holds grants from Johnson & Johnson and Medtronic and is a consultant to Medtronic, Mentice, Microvention, Philips, and Stryker. Dr Gopinathan is a consultant for Microvention and has received other payments from Medtronic, Penumbra Inc, and Stryker corporation. Dr Ganesh is a consultant for Atheneum, Figure 1, MD Analytics, and MyMedicalPanel; has stocks in Collavidence Inc; has stock options in SnapDX Inc; received a grant from Microvention Inc; has received other payments from Alexion Pharmaceuticals, Biogen; and reports grants from Heart and Stroke Foundation of Canada. Dr Volders is a consultant for Penumbra Inc. Dr Yavagal is a consultant for Athersys, Gravity Medical Technology, Johnson & Johnson Healthcare systems Inc, Medtronic USA Inc, Poseydon, Stryker Corporation, and Vascular Dynamics; has stocks in Athersys; and has stock options in Poseydon and Rapid Medical. Dr Sandset has received other payments from AstraZeneca, Bayer, Boston Scientific Corporation, Bristol-Myers Squibb, and Daiichi Sankyo Company. Dr Psychogios has received grants from Medtronic, Penumbra Inc, Phenox Inc, Rapic Medical Ltd, Siemens Healthineers AG, Stryker Neurovascular Inc, and Swiss National Science foundation; has travel support from Medtronic, Penumbra Inc, Phenox Inc, Siemens Healthineers AG, and Stryker Neurovascular Inc; and is a consultant to Siemens Healthineers AG. Dr Kurz has received a grant from the Laerdal Foundation for Acute Medicine. Dr Hill holds grants from Medtronic and Microvention and is employed by the University of Calgary. Dr Bhogal is a consultant to Balt USA, LLC, Brainomix, Cerenovus, NeuroVasc Technologies Inc, Vesalio, and Phenox Inc; and has received travel support from Perflow. Dr Martins has received other payments from Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo Company, Medtronic, Novartis, Novo Nordisk, Penumbra Inc, Pfizer, and Servier Affaires Medicales. Dr Tjoumakaris is a consultant to Microvention. Dr Nguyen is a consultant to Aruna and Brainomix and has received other payments from the American Stroke Association. Dr Inoa is a consultant to Cerenovus, Medtronic, Microvention, Penumbra, Siemens, and Viz.ai; holds a grant from Medtronic; is employed by the University of Calgary; and reports employment by Semmes Murphey Clinic. The other authors report no conflicts.

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Challenges to Widespread Implementation of Stroke Thrombectomy

Affiliations

Challenges to Widespread Implementation of Stroke Thrombectomy

Authors

Affiliations

Abstract

Conflict of interest statement

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