SVIN: Mission Thrombectomy News – April 16, 2025

Advancing Global Stroke Justice: The Imperative for a Unified Ecosystem of Access, Outcomes, and Intervention

By Fredrick L. Echols, M.D.

Introduction: Stroke is a leading cause of death and long-term disability worldwide, representing a critical test of any nation's healthcare system. Every minute counts in stroke care, particularly in the context of large vessel occlusion (LVO) strokes where timely mechanical thrombectomy (MT) can drastically improve outcomes. However, despite significant advancements in neurointerventional techniques and systems of care, vast disparities persist in stroke care access and delivery. These disparities are not confined to low-resource settings; they also exist within high-income countries like the United States. Addressing these systemic gaps is both a medical and moral imperative. A robust, scalable, and equitable stroke care ecosystem—such as the one envisioned by the Society of Vascular and Interventional Neurology (SVIN) through its Mission Thrombectomy Program—can bridge these divides.

Comparative Access and Outcomes in Stroke Care. The global landscape of stroke care reveals striking disparities. In high-income countries (HICs), more than 90% report the availability of dedicated stroke units, compared to fewer than 10% in low-income countries (LICs) (Feigin et al., 2021). Acute interventions such as intravenous thrombolysis and MT are similarly inequitably distributed. A study by Campbell et al. (2019) found that MT was available in only 26% of LICs, in contrast to over 60% of HICs.

Even within the United States, access to MT is often determined by geography, socioeconomic status, and the initial hospital of care. Patients presenting to non-thrombectomy-capable centers have significantly lower odds of receiving MT (Kamal et al., 2021). This contributes to preventable disability and mortality, particularly in rural and underserved urban communities. According to data published by The Commonwealth Fund, the U.S. ranks last in healthcare system performance compared to peer nations, despite leading per capita healthcare spending (Schneider et al., 2021).

Mechanical Thrombectomy Access Score and Ecosystem Efficiency. To systematically assess access disparities, the Mechanical Thrombectomy Access Score (MTAS) has been developed as a global benchmarking tool (Zaidat et al., 2024). MTAS incorporates multiple dimensions of stroke system readiness—including geographic availability, procedural capability, workforce density, and infrastructure—to provide a holistic measure of regional access. High MTAS scores correlate with lower time-to-treatment intervals and improved functional outcomes at 90 days post-stroke.

However, achieving high MTAS scores remains elusive for many LMICs. Major barriers include workforce shortages, limited diagnostic imaging capacity, and inadequate prehospital systems. These structural inefficiencies are compounded by a lack of national policy prioritization for stroke care and prevention.

Promise of the SVIN Mission Thrombectomy Program. The SVIN Mission Thrombectomy Program exemplifies a translational model for improving stroke care equity. By training physicians, establishing thrombectomy-capable centers, and advocating for systemic reforms, the program actively reduces time-to-treatment and improves outcomes in resource-rich and resource-limited settings. Participating centers report increased MT rates and improved modified Rankin Scale (mRS) scores at 90 days (SVIN, 2023).

Importantly, the program promotes ecosystem thinking. It does not treat thrombectomy in isolation but integrates MT into a broader stroke system, including emergency medical services (EMS), imaging, telestroke networks, and post-acute care. This holistic approach is particularly valuable in LMICs, where fragmented care systems and resource constraints demand integrated, scalable solutions.

Call to Action. Efforts to improve stroke care must be coordinated, data-driven, and global in scope. Physicians and healthcare professionals are urged to engage with initiatives like the SVIN Mission Thrombectomy Program, contributing their expertise to local and international efforts. Policymakers should enact legislation and allocate funding to build and sustain stroke systems of care, including telemedicine networks, MT training programs, and EMS integration.

Furthermore, laypersons and patient advocates can play a critical role in raising public awareness of stroke symptoms and the importance of rapid medical attention. Time is brain, and every stakeholder—from laypersons to clinicians and elected officials—has a role to play in building a stroke care ecosystem that delivers equitable, high-quality care to all.

Conclusion: Global disparities in stroke care are both a clinical challenge and a human rights issue. High-, middle-, and low-income countries have a stake in creating more equitable, efficient, and responsive stroke care systems. The SVIN Mission Thrombectomy Program offers a compelling blueprint for such transformation. By supporting programs that build infrastructure, train personnel, and integrate care systems, the global medical community can collectively advance toward a future where access to life-saving stroke treatment is not a matter of geography or income, but a shared standard of care.

References

• Campbell BCV, et al. (2019). "Organized stroke systems of care: A global perspective." Lancet Neurology, 18(7), 684–690.
• Feigin VL, et al. (2021). "Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis." The Lancet Neurology, 20(10), 795–820.
• Kamal N, et al. (2021). "Delays in endovascular therapy for acute stroke: a systematic review." Journal of NeuroInterventional Surgery, 13(7), 579–585.
• Schneider EC, et al. (2021). "Mirror, Mirror 2021: Reflecting Poorly." The Commonwealth Fund.
• Zaidat OO, et al. (2024). "Global Access to Mechanical Thrombectomy: The Mechanical Thrombectomy Access Score (MTAS)." Stroke, 55(1), 112–120.
• Society of Vascular and Interventional Neurology (SVIN). (2023). Mission Thrombectomy Program Impact Report. SVIN Publications.

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