Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy

Aroor S.R.; Zevallos C.B.; Asif K.S.; Singh N.; Potter-Vig J.; Rodriguez-Calienes A.; Menon B.K.; Ganesh A.; Saver J.L.; Kamel H.; Alexandrov A.W.; Jauch E.C.; Miao Z.; Huo X.; Ramakrishnan P.; Desai S.M.; Limaye K.; El-Ghanem M.; Toth G.; Rao C.V.; Masoud H.E.; Wang Q.T.; Herial N.A.; Atchaneeyasakul K.; Szeder V.; Amuluru K.; Urrutia V.C.; Al-Mufti F.; Yavagal D.R.; Ortega-Gutierrez S. · Stroke (2025) · DOI: 10.1161/strokeaha.124.047805

Resumen

BACKGROUND: The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. METHODS: We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. RESULTS: Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. CONCLUSIONS: The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.

Instituciones: Universidad Científica del Sur