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Updated: Dec 28, 2025
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
12.4K
Endovascular Thrombectomy for Acute Ischemic Strokes: Current US Access Paradigms and Optimization Methodology
Amrou Sarraj1, Sean Savitz2, Deep Pujara1
1From the Department of Neurology, The University of Texas at Houston (A. Sarraj, D.P., H.K., F.S., S.R., K.P., L.E.F., E.M.J., A. Sharrief).
Stroke
|February 21, 2020
Summary
Improving access to endovascular thrombectomy (EVT) for stroke patients is crucial. Bypassing non-EVT centers significantly increases direct EVT access, highlighting a promising strategy for better patient outcomes.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Timely access to endovascular thrombectomy (EVT) is critical for optimal acute ischemic stroke outcomes.
- Geographic disparities in EVT center access affect a significant portion of the US population.
Purpose of the Study:
- To map US stroke-treating centers and assess current direct EVT access.
- To evaluate the effectiveness of two optimization models for increasing EVT access.
Main Methods:
- Geo-mapping of US stroke centers, stratifying them into EVT and non-EVT facilities.
- Calculation of direct EVT access using validated trauma models adapted for stroke.
- Application of two optimization models: Model-A (converting non-EVT to EVT centers) and Model-B (bypassing non-EVT centers).
Main Results:
- Only 19.8% of Americans have direct EVT access within 15 minutes; 30.9% within 30 minutes.
- Model-A (flipping 10% non-EVT centers) increased 15-minute access by 7.5% nationwide.
- Model-B (bypassing non-EVT centers) resulted in a 16.7% nationwide gain in 15-minute EVT access, showing greater potential.
Conclusions:
- Current direct EVT access within 15 minutes is limited to less than one-fifth of the US population.
- Both increasing EVT centers and bypassing non-EVT centers enhance access, with bypassing showing more potential.
- State-level efforts should identify gaps and tailor solutions to improve EVT access, considering population density and size.
