Nav: Home

Less than 20% of Americans have rapid access to endovascular thrombectomy for stroke

March 03, 2020

Timely treatment is critical for stroke victims, yet only 19.8% of the U.S. population can access a stroke center capable of endovascular thrombectomy to remove a large clot in 15 minutes or less by ambulance, according to researchers from The University of Texas Health Science Center at Houston (UTHealth). Only 30% of Americans can access a thrombectomy-equipped center in 30 minutes.

The study, published in Stroke, assessed the current state of access to endovascular thrombectomy treatment in the U.S. and evaluated two different strategies to optimize it.

Stroke is the leading cause of long-term disability and fourth-leading cause of death in the world. An ischemic stroke, caused by a blockage of an artery, is the most common form. Endovascular thrombectomy can be performed to remove a clot lodged in a blood vessel with a mechanical device threaded through an artery. Research shows it is an effective treatment for improving clinical outcomes in stroke up to 24 hours from onset, but currently not everyone can have it done.

"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," said Amrou Sarraj, MD, lead author and associate professor of neurology at McGovern Medical School at UTHealth. Sarraj is also a member of the UTHealth Institute for Stroke and Cerebrovascular Disease.

One strategy, the flipping model, would convert a percentage of hospitals within geographic areas to be endovascular thrombectomy-capable. The second method, the bypassing model, would transport patients directly to hospitals capable of thrombectomy, bypassing facilities that aren't when the reroute would take less than 15 minutes.

The 15-minute bypassing model improved access by 16.7%, meaning about 51.7 million more people would be able to have an endovascular thrombectomy procedure in a timely manner. This model is also easier and more cost-effective to implement, according to the authors.

"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 (tPA) 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," Sarraj said.

The flipping model, which equips 10% of the most impactful hospitals to do thrombectomies, improved 15-minute access by 7.5%, and would work best in areas with more plentiful stroke care resources.

"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," Sarraj said.

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, Sarraj said.

"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 neuro-interventionalists 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," Sarraj said.
Other McGovern Medical School authors include Sean Savitz, MD; Deep Pujara, MD; Harris Kamal, MD; Faris Shaker, MD; Sujan Reddy, MD; Kaushik Parsha, MD, MS; Lauren E. Fournier, MD; Erica M. Jones, MD, MPH; Anjail Sharrief, MD, MPH; and the senior author was James Grotta, MD. Savitz is director and Kamal, Sharrief, and Grotta are members of the UTHealth Institute for Stroke and Cerebrovascular Diseases.

University of Texas Health Science Center at Houston

Related Stroke Articles:

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.
How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.
Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.
High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.
Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.
We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.
Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.
Stroke affects more than just the physical
A new study looks at what problems affect people most after a stroke and it provides a broader picture than what some may usually expect to see.
Stroke journal features women's studies on how gender influences stroke risk, treatment and outcomes
Many aspects of strokes affect women and men differently, and four articles in the American Heart Association's journal Stroke highlight recent research and identify future research needs.
Too few with stroke of the eye are treated to reduce future stroke
Only one-third of 5,600 patients with retinal infarction, or stroke in the eye, underwent basic stroke work-up, and fewer than one in 10 were seen by a neurologist.
More Stroke News and Stroke Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at