Access to Endovascular Thrombectomy for Stroke in Rural Versus Urban Regions. (26th January 2022)

• Record Type: Journal Article
• Authors: Yan, Yi; Hu, Kai; Alcock, Susan; Ghrooda, Esseddeeg; Trivedi, Anurag; McEachern, James; Kaderali, Zul; Shankar, Jai
• Is Part Of: Canadian journal of neurological sciences. Volume 49:Number 1(2022)
• Page Start: 70
• Page End: 75
• Publication Date: 2022-01-26
• Subjects: Ischemic stroke -- EVT -- Rural -- Onset-to-CTA time and onset-to-groin puncture time; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2021.35
• Languages: English
• ISSNs: 0317-1671

Abstract

ABSTRACT: Purpose: Endovascular thrombectomy (EVT) significantly improves outcomes for acute ischemic stroke patients with large vessel occlusion (LVO) who present in a time sensitive manner. Prolonged EVT access times may reduce benefits for eligible patients. We evaluated the efficiency of EVT services including EVT rates, onset-to-CTA time and onset-to-groin puncture time in our province. Materials and methods: Three areas were defined: zone I- urban region, zone II-areas within 1 h drive distance from the Comprehensive Stroke Center (CSC); and zone III-areas more than 1hr drive distance from the CSC. In this retrospective cohort study, EVT rate, onset-to-groin puncture time and onset-to-CTA time were compared among the three groups using Krustal–Wallis and Wilcoxon tests. Results: The EVT rate per 100, 000 inhabitants for urban zone I was 8.6 as compared to 5.1 in zone II, and 7.5 in zone III. Compared to zone I (114 min; 95% CI (96, 132); n = 128), mean onset-to-CTA time was 19 min longer in zone II (133 min; 95% CI (77, 189); n = 23; p = 0.0459) and 103 min longer in zone III (217 min, 95% CI (162, 272); n = 44; p < 0.0001). Compared to zone I (209 min, 95% CI (181, 238)), mean onset-to-groin puncture time was 22 min longer in zone II (231 min, 95% CI (174, 288); p = 0.046) but 163 min longer in zone III (372 min, 95% CI (312, 432); p < 0.0001). Conclusion: EVT access in rural areas is considerably reduced with significantly longer onset-to-groin puncture times and onset-to-CTA times when compared to our urban area. This may help in modifying the patient transfer policy for EVT referral.