Stroke Patients: Thrombectomy Eligibility And Its Limitations

what percentage of stroke patients are eligible for thrombectomy

The percentage of stroke patients eligible for thrombectomy varies depending on the criteria used to determine eligibility. For example, a 2022 study found that between 6.32% and 11.70% of all ischemic stroke patients were eligible for thrombectomy, while another 2020 study found that 13% of patients were eligible. However, it's important to note that these percentages may not be directly comparable as they are based on different populations and criteria. Additionally, the percentage of eligible patients has increased over time due to advancements in treatment options and changes in clinical practice.

Characteristics Values
% of ischemic stroke patients eligible for thrombectomy 4.8% - 13%
% of ischemic stroke patients eligible for thrombectomy (permissive criteria) 13% - 22%
% of ischemic stroke patients initially cared for at a thrombectomy hub 48.7%
% of ischemic stroke patients initially cared for at a thrombectomy gateway 35.3%
% of ischemic stroke patients initially cared for at a thrombectomy gap 16.0%
% of patients initially cared for at thrombectomy gateways who ultimately underwent thrombectomy 1.3%
% of patients initially cared for at thrombectomy hubs who ultimately underwent thrombectomy 4.8%
% of patients with acute ischemic stroke who underwent thrombectomy 14.0%
% of patients with acute ischemic stroke who were potentially eligible for thrombectomy 48.7%

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The percentage of stroke patients eligible for thrombectomy in France

Another study, which used data from the Northern French Alps Emergency Network (RENAU), found that thrombectomy could be performed in 26% of acute ischemic stroke patients. However, it is important to note that the eligibility criteria and study methods may vary between studies, making direct comparisons difficult.

In terms of regional disparities, one study found that the greatest need for increased mechanical thrombectomy (MT) activity in France was in Brittany, Pays de la Loire, and Corsica. This suggests that there may be unequal access to MT across different regions of the country.

Overall, while the exact percentage of stroke patients eligible for thrombectomy in France is not definitively known, studies suggest that it is a relatively small proportion of all ischemic stroke cases, and that there may be regional variations in eligibility and access to this treatment.

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The percentage of stroke patients eligible for thrombectomy in Adelaide, Australia

Thrombectomy is a standard treatment for ischemic stroke patients with large vessel occlusion. However, the percentage of stroke patients eligible for this treatment is not well known. A study conducted in Adelaide, Australia, provides some insights on the eligibility criteria and the percentage of stroke patients who may be eligible for thrombectomy in this region.

The Adelaide Stroke Incidence Study (ASCEND) was a population-based study conducted in the western suburbs of Adelaide, South Australia, from July 2009 to July 2010. The study involved a population of 148,027 people, and during the one-year study period, 318 strokes occurred (a crude attack rate of 215 per 100,000 person-years).

To determine eligibility for endovascular thrombectomy (ET), the study used two algorithms: a restrictive algorithm and a permissive algorithm. The restrictive algorithm included criteria such as a modified Rankin Scale score of 0-1, a presentation delay of less than 3.5 hours, and target mismatch penumbra. The permissive algorithm had less stringent criteria, including a modified Rankin Scale score of 0-3 and a presentation delay of less than 5 hours.

Using the restrictive algorithm, the study found that 17 out of 258 definite ischemic strokes (7%) were eligible for ET. With the permissive algorithm, an additional 16 patients were identified, bringing the total to 33 out of 258 (13%). This equates to 11 potential ET cases per 100,000 person-years with the restrictive algorithm and 22 cases per 100,000 person-years with the permissive algorithm.

In summary, the study suggests that in Adelaide, Australia, approximately 7% of ischemic stroke patients are potentially eligible for ET using restrictive criteria, and this percentage increases to 13% when using more permissive criteria. These findings can help guide the development of hyperacute services and improve access to this effective treatment for stroke patients in the region.

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The percentage of stroke patients eligible for thrombectomy in the US

Stroke is a leading cause of death and disability worldwide. Endovascular thrombectomy (ET) is a standard treatment for ischemic stroke patients with large vessel occlusion (LVO). However, the number of stroke patients eligible for ET is not well known. This figure is crucial for planning hyper-acute services and ensuring equal access to treatment.

Eligibility criteria

Eligibility for ET is determined by stroke subtype, pathogenesis, severity, premorbid modified Rankin Score, presentation delay, LVO, and target mismatch penumbra. Centers may interpret recent ET trials either loosely or rigidly, so two eligibility algorithms are often applied: restrictive (key criteria modified Rankin Scale score 0–1, presentation delay <3.5 hours, and target mismatch penumbra) and permissive (modified Rankin Scale score 0–3 and presentation delay <5 hours).

Eligibility rates

In a 2016 Australian study, 7% of ischemic strokes were eligible for ET according to restrictive criteria, and 13% according to permissive criteria. A 2019 US study found that 10.7% of patients aged 80+ and 16.2% of patients under 80 were eligible for ET. A 2021 study of 11 US states found that 48.7% of ischemic stroke patients initially received care at thrombectomy hubs, 35.3% at thrombectomy gateways, and 16.0% at thrombectomy gaps. A 2022 study found that 14.0% of 302,965 potentially eligible patients received ET.

Disparities

Rural patients in the US have less access to thrombectomy, with 27.7% initially receiving care at hubs vs. 69.5% of urban patients. Minority patients in the US continue to have lower MT rates. A 2018 study found that Black/Hispanic patients’ treatment rate was 2.8% lower than White/non-Hispanic patients (7% vs. 9.8%).

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The percentage of stroke patients eligible for thrombectomy in West Virginia, US

The percentage of stroke patients eligible for thrombectomy is a crucial indicator for developing systems of care and allocating resources. Endovascular thrombectomy (ET) is a standard treatment for ischemic stroke patients with large vessel occlusion (LVO), but population-based studies on eligibility are scarce. This analysis aims to determine the percentage of stroke patients eligible for thrombectomy in West Virginia, US, and provide insights into the state's stroke care system.

Methods

Data on ischemic stroke patients discharged over three years (March 2012 - March 2015) from a tertiary-level hospital in northern West Virginia, serving a large geographic area, were evaluated. The hospital's four-county primary service area (PSA) had a population of 210,000 during the study period. The incidence of LVO was determined for the PSA based on each county's discharges, and eligibility for thrombectomy was assessed using time (<6 hours from symptom onset) and imaging criteria (Alberta Stroke Program Early CT Score (ASPECTS) ≥6).

Results

Of the 1157 patients discharged from the PSA with ischemic stroke, 129 (11.1%, 95% CI: 9.5%-13.1%) had an LVO. This translates to an LVO incidence of 24 per 100,000 people per year (95% CI: 20-28). When considering only anterior circulation LVOs, the incidence was 20 per 100,000 people per year (95% CI: 19-22). Of these, 10 per 100,000 people per year (95% CI: 8-11) were eligible for thrombectomy based on time and imaging criteria. Additionally, 5 per 100,000 people per year (95% CI: 3-6) presented with favorable ASPECTS after 6 hours of symptom onset.

Discussion

The results indicate that a substantial proportion of ischemic stroke patients in West Virginia may benefit from thrombectomy. The estimated LVO incidence of 24 per 100,000 person-years (95% CI: 20-28) is within the range of previous estimates. The study highlights the potential for growth in endovascular stroke therapy and the need to develop systems of care to improve access to thrombectomy.

The analysis suggests that approximately 10-11% of ischemic stroke patients in West Virginia may be eligible for thrombectomy. This data emphasizes the importance of continued efforts to optimize stroke care systems and enhance access to thrombectomy for eligible patients in the state.

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The percentage of stroke patients eligible for thrombectomy in Germany

Stroke is a leading cause of morbidity and mortality globally. Endovascular thrombectomy is a standard treatment for ischemic stroke patients with large vessel occlusion (LVO), but estimates of eligible patients vary. This analysis aims to determine the percentage of stroke patients eligible for thrombectomy in Germany, using nationwide comprehensive administrative data.

Methods

Data on hospitalized cases with the main diagnosis of acute ischemic stroke (AIS) in Germany for the year 2019 were considered. Stroke therapies were identified using corresponding Operating and Procedure Keys for intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) from German Diagnosis-Related Groups (G-DRG) statistics. Regional analyses were performed based on data from 412 German administrative districts and cities.

Results

The number of hospitalized AIS patients in Germany showed a mild decrease from 227,687 in 2016 to 225,531 in 2019. The rate of IVT increased from 14.9% in 2016 to 16.3% in 2019. The MT rate also increased significantly from 4.3% in 2016 to 7.2% in 2019. There was a high regional variability in MT rates, ranging from 1.4% to 15.2% according to the place of residence of AIS patients.

Discussion

The rates of recanalization therapies for AIS patients in Germany continued to increase from 2016 to 2019, with a more pronounced increase in MT procedures compared to IVT. The MT rate in Germany is far above the European average and each of the 412 districts/cities had at least one resident treated with MT in 2019, indicating its widespread availability. However, there are still major differences in MT rates across regions, with lower rates in rural eastern and southern parts of the country. The increase in MT rates is likely due to the growing evidence for its effectiveness and extended time window for treatment. Providing MT to all eligible AIS patients remains an ongoing challenge.

Frequently asked questions

The percentage of stroke patients eligible for thrombectomy depends on the criteria used to determine eligibility. In a study of patients with ischemic strokes, 7% were eligible for thrombectomy using restrictive criteria, and 13% were eligible using permissive criteria.

Restrictive criteria include key criteria such as a modified Rankin Scale score of 0-1, presentation delay of less than 3.5 hours, and target mismatch penumbra. Permissive criteria include a modified Rankin Scale score of 0-3 and presentation delay of less than 5 hours.

There were 205,681 patients with ischemic stroke in the United States across 11 states in 2016-2018.

Fewer than 50% of stroke patients in the United States have access to thrombectomy, even after accounting for interhospital transfers.

The use of thrombectomy among stroke patients has increased over time, particularly after 2015 when several randomized clinical trials demonstrated its benefits.

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