Open AccessNationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal
Author(s) -
Mariana Carvalho Dias,
Ricardo Soares-dos-Reis,
João Vasco Santos,
Ana Paiva Nunes,
Patrı́cia Ferreira,
Bruno Maia,
Isabel Fragata,
João Carlos R. Reis,
Joana Ramos Lopes,
Luís Cruz,
Gustavo Santo,
Egídio Machado,
Denis Gabriel,
Rui Felgueiras,
Hugo Mota Dória,
Ângelo Carneiro,
Manuel Correia,
Laura de Sousa Gomes Veloso,
Pedro Barros,
Tiago Gregório,
Andreia Carvalho,
Manuel Ribeiro,
Pedro Teotonio,
Lia Neto,
Teresa Pinho e Melo,
Patrı́cia Canhão,
João Pedro Filipe,
Goreti Moreira,
Elsa Azevedo,
Maria Luís Silva,
Elisa Costa,
Guilherme H. Oliveira,
Liliana Pereira,
Lígia de Amorim Neves,
Miguel Rodrigues,
João Pedro Marto,
Sofia Calado,
Fátima Grenho,
Gabriel Branco,
Tiago Baptista,
Jaime Rocha,
Carla Ferreira,
João Pinho,
José Amorim,
José Manuel Araújo,
Rui Neiva,
João L. Viana,
Mariana F. Lobo,
Alberto Freitas,
Vítor Tedim Cruz,
João Sargento-Freitas,
Joanne Lopes
Publication year - 2022
Publication title -
acta médica portuguesa
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.316
H-Index - 21
eISSN - 1646-0758
pISSN - 0870-399X
DOI - 10.20344/amp.15031
Subject(s) - endovascular treatment , medicine , stroke (engine) , mainland , emergency medicine , cohort , descriptive statistics , surgery , geography , mechanical engineering , statistics , mathematics , archaeology , engineering , aneurysm
Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts.Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture.Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity.Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.