Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access)

Ahmed Nasreldein¹, Wan Asyraf², Thanh N Nguyen³, Sheila Martins^{4

5}, Vasileios-Arsenios Lioutas⁶, Ahmed Elbassiouny⁷, Mai Duy Ton^{8

9

10}, Simona Sacco¹¹, Mohamed A Micdhadhu¹², Yimin Chen^{13

14}, Rufus Akinyemi¹⁵, Espen Saxhaug Kristoffersen¹⁶, Xiaochuan Huo¹⁷, Zhongrong Miao¹⁸, Mohamad Abdalkader¹⁹, Simon Nagel²⁰, Volker Puetz²¹, Gotz Thomalla²², Hiroshi Yamagami²³, Zhongming Qiu²⁴, Jelle Demeestere²⁵, Adnan I Qureshi²⁶, Patrik Michel²⁷, Daniel Strbian²⁸, Bruce Cv Campbell²⁹, Bernard Yan³⁰, Abdulhakeem Olorukooba³¹, Hesham E Masoud³², Diogo C Haussen³³, Michael Frankel³³, Mahmoud H Mohammaden^{33

34}

Affiliations

¹ Department of Neurology, Assiut University, Assiut, Egypt.
² Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
³ Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁴ Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁵ Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
⁶ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁷ Department of Neurology, Ain Shams University, Cairo, Egypt.
⁸ Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.
⁹ VNU-University of Medicine and Pharmacy, Hanoi, Vietnam.
¹⁰ Hanoi Medical University, Hanoi, Vietnam.
¹¹ Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
¹² Department of Neurology, Hospital Seberang Jaya, Pulau Pinang, Malaysia.
¹³ Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China.
¹⁴ Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹⁵ Neuroscience and Aging Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁶ Department of Neurology, Akershus University Hospital, Akershus, Norway.
¹⁷ Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹⁸ Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
¹⁹ Department of Radiology, Boston Medical Center, Boston, MA, USA.
²⁰ Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
²¹ Department of Neurology and Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technischen Universität Dresden, Dresden, Germany.
²² Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
²³ Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
²⁴ Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
²⁵ Department of Neurology, Leuven University Hospital, Leuven, Belgium.
²⁶ Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO, USA.
²⁷ Lausanne University Hospital, Lausanne, Switzerland.
²⁸ Neurology, University of Helsinki, Helsinki, Finland.
²⁹ Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
³⁰ Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia.
³¹ Department of Community Medicine, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
³² Department of Neurology, The State University of New York, Syracuse, NY, USA.
³³ Department of Neurology, Grady memorial Hospital, Emory University, Atlanta, GA, USA.
³⁴ Department of Neurology, Faculty of Medicine, South Valley University, Qena, Egypt.

PMID: 39773209
DOI: 10.1177/17474930251314395

Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access)

Ahmed Nasreldein et al. Int J Stroke. 2025 Jul.

. 2025 Jul;20(6):660-668.

doi: 10.1177/17474930251314395. Epub 2025 Feb 3.

Authors

Affiliations

¹ Department of Neurology, Assiut University, Assiut, Egypt.
² Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
³ Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁴ Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁵ Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
⁶ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁷ Department of Neurology, Ain Shams University, Cairo, Egypt.
⁸ Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.
⁹ VNU-University of Medicine and Pharmacy, Hanoi, Vietnam.
¹⁰ Hanoi Medical University, Hanoi, Vietnam.
¹¹ Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
¹² Department of Neurology, Hospital Seberang Jaya, Pulau Pinang, Malaysia.
¹³ Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China.
¹⁴ Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹⁵ Neuroscience and Aging Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁶ Department of Neurology, Akershus University Hospital, Akershus, Norway.
¹⁷ Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹⁸ Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China.
¹⁹ Department of Radiology, Boston Medical Center, Boston, MA, USA.
²⁰ Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
²¹ Department of Neurology and Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technischen Universität Dresden, Dresden, Germany.
²² Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
²³ Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
²⁴ Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
²⁵ Department of Neurology, Leuven University Hospital, Leuven, Belgium.
²⁶ Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO, USA.
²⁷ Lausanne University Hospital, Lausanne, Switzerland.
²⁸ Neurology, University of Helsinki, Helsinki, Finland.
²⁹ Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
³⁰ Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia.
³¹ Department of Community Medicine, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
³² Department of Neurology, The State University of New York, Syracuse, NY, USA.
³³ Department of Neurology, Grady memorial Hospital, Emory University, Atlanta, GA, USA.
³⁴ Department of Neurology, Faculty of Medicine, South Valley University, Qena, Egypt.

PMID: 39773209
DOI: 10.1177/17474930251314395

Abstract

Background: Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.

Aim: Our aim was to determine the key challenges for MT implementation and access worldwide.

Methods: We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country.

Results: We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program.

Conclusion: Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.

Keywords: CT; MRI; Mechanical thrombectomy; challenges; stroke.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.N. and M.H.M.: no disclosure. D.C.H. is a consultant for Stryker and Vesalio and holds stock options at Viz.AI. T.N.N.: Research support from Medtronic, advisory board Brainomix, Associate Editor of Stroke. The other authors report no conflicts.

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Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access)

Affiliations

Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access)

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources

Medical