Less than ⅕ of US stroke patients have timely access to thrombectomy
Just under 20% of Americans have rapid access to endovascular thrombectomy for stroke, according to a study out of the University of Texas Health Science Center at Houston.
Endovascular thrombectomy, which can remove a life-threatening blood clot within 15 minutes, is key for ischemic stroke recovery, lead author Amrou Sarraj, MD, and colleagues at UTHealth wrote in Stroke. Previous research has proven thrombectomy is an effective approach to stroke care when performed within 24 hours of the index event, but access is a big problem in the U.S.
“This is a significant unmet need in stroke care, as the majority of stroke patients may not have timely access to thrombectomy, a highly effective treatment,” Sarraj said in a statement.
The authors found in their study that under one-third of Americans—30%—would be able to access a thrombectomy-equipped center within 30 minutes of stroke onset. Worse, just 19.8% would be able to access such a clinic within 15 minutes. The team discussed two options for improving those stats:
The flipping model
The flipping model would convert a portion of hospitals within a certain geographic area to thrombectomy-capable centers. Ten percent of the “most impactful hospitals” would be equipped with everything they need to perform endovascular thrombectomies in a pinch.
“The flipping approach emphasizes infrastructure development,” Sarraj said. “When ample resources are available, this may result in providing access in areas that are currently devoid of thrombectomy services.”
When the authors tested the flipping model, they found that 15-minute access to endovascular thrombectomy improved by 7.5%. Sarraj said the approach would likely work best in areas with plenty of stroke care resources.
The bypassing model
On the other hand, what the team called the bypassing model would transport patients directly to hospitals capable of thrombectomy, bypassing any facilities that aren’t. Medical centers would be bypassed if a reroute to a better-equipped center would take less than 15 minutes.
In tests, the 15-minute bypassing model improved access to stroke care by 16.7%. Sarraj said that means around 51.7 million more people could have access to endovascular thrombectomy in a timely manner, and the approach is easier and more cost-effective than the flipping model.
“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,” he said. “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.
“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.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.