Endovascular treatment (EVT) for acute ischemic stroke is one of the most efficacious and effective treatments in medicine, yet globally, its implementation remains limited. Patterns of EVT underutilization exist in virtually any health care system and range from a complete lack of access to selective undertreatment of certain patient subgroups. In this review, we outline different patterns of EVT underutilization and possible causes. We discuss common challenges and bottlenecks that are encountered by physicians, patients, and other stakeholders when trying to establish and expand EVT services in different scenarios and possible pathways to overcome these challenges. Lastly, we discuss the importance of implementation research studies, strategic partnerships, and advocacy efforts to mitigate EVT underutilization.
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http://dx.doi.org/10.1161/STROKEAHA.124.045889 | DOI Listing |
Stroke
August 2024
Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
J Stroke Cerebrovasc Dis
March 2023
University of Pennsylvania, Department of Neurology. Electronic address:
Objectives: Atrial fibrillation (AF) is responsible for 30-50% of large strokes requiring endovascular thrombectomy (EVT). Anticoagulation (AC) underutilization is a common source of AF-related stroke. We compared antithrombotic medications among stroke patients with AF that did or did not undergo EVT to determine if AC underutilization disproportionately results in strokes requiring EVT, while quantifying the proportion of likely preventable thrombectomies.
View Article and Find Full Text PDFStroke
March 2022
Department of Neurology (Y.K., A.S., S.K., R.A., S.S.-M., G.-Q.Z., S.A.S.), McGovern Medical School, The University of Texas Health Science Center at Houston.
Background And Purpose: Endovascular therapy (EVT) is a very effective treatment but relies on specialized capabilities that are not available in every hospital where acute ischemic stroke is treated. Here, we assess whether access to and utilization of this therapy has extended uniformly across racial and ethnic groups.
Methods: We conducted a retrospective, population-based study using the 2019 Texas Inpatient Public Use Data File.
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