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Abstract
Purpose of the Review To provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.
Recent Findings Randomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients.
Summary Stroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.
Glossary
- AHA/ASA=
- American Heart Association/American Stroke Association;
- AIS=
- acute ischemic stroke;
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- CI=
- confidence interval;
- DALY=
- disability-adjusted life-year;
- ED=
- emergency department;
- HS=
- hemorrhagic stroke;
- IS=
- ischemic stroke;
- IVT=
- IV thrombolysis;
- LVO=
- large vessel occlusion;
- MCA=
- middle cerebral artery;
- mRS=
- modified Rankin Scale;
- MSU=
- mobile stroke unit;
- MT=
- mechanical thrombectomy;
- MT2020+=
- Mission Thrombectomy 2020+;
- mTICI=
- modified Thrombolysis in Cerebral Infarction;
- NINDS=
- National Institute of Neurological Disorders and Stroke;
- OR=
- odds ratio;
- QALY=
- quality-adjusted life-year;
- RCT=
- randomized clinical trial;
- rtPA=
- recombinant tissue plasminogen activator
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received June 27, 2020.
- Accepted in final form June 23, 2021.
- © 2021 American Academy of Neurology
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