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Access to Endovascular Treatment in Remote Areas

2016; Lippincott Williams & Wilkins; Volume: 47; Issue: 5 Linguagem: Inglês

10.1161/strokeaha.116.013069

1524-4628

Natàlia Pérez de la Ossa, Sònia Abilleira, Laura Dorado, Xabier Urra, Marc Ribó, Pere Cardona, E. Giralt, Joan Martí‐Fàbregas, Francisco Purroy, Joaquı́n Serena, David Cánovas, Moisès Garcés, Jerzy Krupiński, Anna Pellisé, Júlia Saura, Carlos A. Molina, Antoni Dávalos, Miquel Gallofré, Raquel Delgado‐Mederos, Alejandro Martínez‐Domeño, Rebeca Marín Bueno, Jaume Roquer, Ana Rodríguez-Campello, Ángel Ois, Jordi Jiménez‐Conde, Elisa Cuadrado‐Godia, Léopoldo Guimaraens, Ángel Chamorro, Vı́ctor Obach, Sergio Amaro, JM Macho, Jordi Blasco, Luís San Román, Antonio López‐Rueda, Antonio Martı́nez-Yélamos, H. Quesada, B Lara, Núria Cayuela, Lucía Aja, MÁ de Miquel, Paloma Mora, Marta Rubiera, J Pagola, David Rodríguez‐Luna, Marián Muchada, Alejandro Tomasello, Pilar Coscojuela, Mónica Millán, Meritxell Gomis, Elena López‐Cancio, Carlos Castaño, Sebastián Remollo, María del Carmen García, J. Estela, J. Perendreu, Sergio Huertas, MC Nicolás, Manuel Gómez‐Choco, Santiago García, Raúl Martínez‐Fernández, Jordi Sanahuja, Mar Castellanos, Yolanda Silva, Cecile van Eendenburg, Rafael Marés, Xavier Ustrell, Joan Josep Baiges, JM Soler Insa, JM Aragonés, Lola Cocho Calderón, Pilar Otermín, Ernest Palomeras,

Stroke Rehabilitation and Recovery

Background and Purpose— Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model. Methods— We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups. Results— Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C. Time from symptom onset to groin puncture was 82 minutes longer in group B (312 minutes [245–435]) and 120 minutes longer in group C (350 minutes [284–408]) compared with group A (230 minutes [160–407]; P <0.001). Conclusions— Accessibility to EVT from remote areas is hampered by lower rate and longer time to treatment compared with areas covered directly by Comprehensive Stroke Centers.