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March 3, 2020

Study Evaluates Strategies to Increase Rapid Access to Endovascular Thrombectomy for Stroke Patients

March 3, 2020—The University of Texas Health Science Center (UTHealth) in Houston, Texas, announced the publication of a study demonstrating that although timely treatment is critical for stroke patients, only 19.8% of the United States population can access a stroke center capable of endovascular thrombectomy to remove a large clot in ≤ 15 minutes by ambulance.

Additionally, the investigators from UTHealth reported that only 30% of Americans can access a thrombectomy-equipped center within 30 minutes. The study assessed the current state of access to endovascular thrombectomy treatment in the United States and evaluated two different strategies to optimize it.

Amrou Sarraj, MD, et al published the study online ahead of print in Stroke. Dr. Sarraj is Associate Professor of Neurology at McGovern Medical School, UTHealth and a member of the UTHealth Institute for Stroke and Cerebrovascular Disease.

As summarized in the UTHealth announcement, one method for improving access, the flipping model, would convert a percentage of hospitals within geographic areas to be endovascular thrombectomy capable. The flipping model would equip 10% of the most impactful hospitals to perform thrombectomies, improve 15-minute access by 7.5%, and would work best in areas with more plentiful stroke care resources.

The second method, the bypassing model, would transport patients directly to hospitals capable of thrombectomy, bypassing facilities that are not capable of treatment when the reroute would take < 15 minutes.

The investigators found that the 15-minute bypassing model improved access by 16.7% with approximately 51.7 million more people able to undergo an endovascular thrombectomy procedure in a timely manner. This model is also easier and more cost-effective to implement.

Dr. Sarraj commented in the UTHealth announcement, “This is a significant unmet need in stroke care, as the majority of stroke patients may not have a timely access to thrombectomy, a highly effective treatment.” He continued, “The bypassing model would alter current stroke treatment paradigms, which still emphasize taking patients to the closest hospital with the ability to administer clot-busting tissue plasminogen activator intravenously, regardless of their thrombectomy capability. It would be an optimal solution for resource-strapped areas, because it leverages the existing infrastructure by triaging patients with large strokes in the field to take them directly to a hospital capable of thrombectomy.”

“The flipping approach emphasizes infrastructure development. When ample resources are available, this may result in providing access in areas that are currently devoid of thrombectomy services. While each approach has pros and cons, both strategies represent a tremendous opportunity to improve the current access to thrombectomy, which would result in significant stroke care improvement.”

Dr. Sarraj advised that the research is the first comprehensive assessment of the status of patient access to thrombectomy in the contemporary era, and it is necessary to know how to effectively improve access in the future. He concluded, “While randomized trials are ongoing for better triage of stroke patients, a few states have already implemented legislation for bypassing hospitals without thrombectomy capability. Having more neurointerventionalists trained and hospitals with the capability to perform thrombectomy would also help increase access. We hope to see more happening on both fronts in the near future to improve stroke care.”

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