You Cannot Manage What You Do Not Measure: Advances in Global Stroke Interventions and the Role of the Mechanical Thrombectomy Access Score

Fawaz Al-Mufti; Zaid Najdawi; Mohamed Elfil; Ankita Jain; Eris Spirollari; Ariel Sacknovitz; Hazem S Ghaith; Priyank Khandelwal; Victor C Urrutia; Nabeel A Herial; Pankajavalli Ramakrishnan; Gabor Toth; Mohammad El-Ghanem; Krishna Amuluru; Viktor Szeder; Jonathan R Crowe; Karol Budohoski; Zurab Nadareishvili; Kaustubh Limaye; Fazeel Siddiqui; Hamza Shaikh; Nishita Singh; Hesham Masoud; Sushanth R Aroor; Shashvat M Desai; Santiago Ortega-Gutierrez; Tareq Kass-Hout; Dileep R Yavagal; Kaiz S Asif; SVIN: Mission Thrombectomy Collaborative

doi:10.1097/CRD.0000000000000914

You Cannot Manage What You Do Not Measure: Advances in Global Stroke Interventions and the Role of the Mechanical Thrombectomy Access Score

Cardiol Rev. 2025 Apr 4. doi: 10.1097/CRD.0000000000000914. Online ahead of print.

Authors

Fawaz Al-Mufti^{1

2}, Zaid Najdawi³, Mohamed Elfil⁴, Ankita Jain^{1

5}, Eris Spirollari^{1

5}, Ariel Sacknovitz^{1

5}, Hazem S Ghaith⁶, Priyank Khandelwal⁷, Victor C Urrutia⁸, Nabeel A Herial⁹, Pankajavalli Ramakrishnan¹⁰, Gabor Toth¹¹, Mohammad El-Ghanem¹², Krishna Amuluru¹³, Viktor Szeder¹⁴, Jonathan R Crowe¹⁵, Karol Budohoski¹⁶, Zurab Nadareishvili¹⁷, Kaustubh Limaye¹⁸, Fazeel Siddiqui¹⁹, Hamza Shaikh²⁰, Nishita Singh²¹, Hesham Masoud²², Sushanth R Aroor²³, Shashvat M Desai²⁴, Santiago Ortega-Gutierrez²⁵, Tareq Kass-Hout²⁶, Dileep R Yavagal⁴, Kaiz S Asif²⁷; SVIN: Mission Thrombectomy Collaborative

Affiliations

¹ From the School of Medicine, New York Medical College, Valhalla, NY.
² Department of Neurology, Westchester Medical Center, Valhalla, NY.
³ Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE.
⁴ Department of Neurology, University of Miami/Jackson Health System, Miami, FL.
⁵ Department of Neurosurgery, Westchester Medical Center, Valhalla, NY.
⁶ Department of Medicine, Al-Azhar University, Cairo, Egypt.
⁷ Department of Neurology, University Hospital, Newark, NJ.
⁸ Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD.
⁹ Department of Neurology, Jefferson Health, Philadelphia, PA.
¹⁰ Department of Neurology, MidHudson Regional Hospital, Poughkeepsie, NY.
¹¹ Department of Neurosurgery, Cleveland Clinic, Cleveland, OH.
¹² Department of Clinical Sciences, University of Houston. HCA Houston Healthcare/HCA Northwest Medical Center, Houston, TX.
¹³ Goodman Campbell Brain and Spine, Indianapolis, IN.
¹⁴ Division of Interventional Neuroradiology, University of California Los Angeles, Los Angeles, CA.
¹⁵ Department of Neurology, University of Virginia, Charlottesville, VA.
¹⁶ Department of Neurosurgery, University of Utah, Salt Lake City, UT.
¹⁷ Department of Neurology, Virginia Hospital Center, Arlington, VA.
¹⁸ School of Medicine, Indiana University, Indianapolis, IN.
¹⁹ Department of Neurology, University of Michigan Health-West, Wyoming, MI.
²⁰ Department of Neuroradiology, Cooper University Health Care, Camden, NJ.
²¹ Division of Neurology, University of Manitoba, Winnipeg, Canada.
²² Department of Neurology, SUNY Upstate Medical University, Syracuse, NY.
²³ Department of Neurology, University of Texas Health Science Center, Houston, TX.
²⁴ Department of Neurology, HonorHealth, Scottsdale, AZ.
²⁵ Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA.
²⁶ Department of Neurology, University of Chicago Medicine, Chicago, IL.
²⁷ Department of Neurosurgery, Ascension Health, Chicago, IL.

PMID: 40183546
DOI: 10.1097/CRD.0000000000000914

Abstract

Global disparities in stroke care, particularly in acute interventions like mechanical thrombectomy (MT), remain profound, with the Mechanical Thombectomy Global Access for Stroke study reporting a median global MT access of just 2.79%. Furthermore, the low- and middle-income countries (LMICs) have been recognized to be disproportionately burdened in this regard as compared with high-income countries. These observed inequities in stroke care impact not only clinical outcomes but also economic productivity and social systems. Recent advancements, such as TeleStroke networks, Mobile Stroke Units, and artificial intelligence-powered tools, have the potential to bridge these gaps. The Mechanical Thrombectomy Access Score (MTAS) offers a novel standardized approach to quantifying barriers to MT access and guiding targeted interventions to mitigate such obstacles. This review explores how MTAS enables the integration of these advancements into global stroke care systems, addressing inequities and optimizing outcomes. Emphasizing the importance of measuring access to manage inequities, we propose strategies to refine and validate MTAS while advocating for systemic investments to enhance global stroke care.

Keywords: endovascular thrombectomy; global access; global medicine; mechanical thrombectomy; stroke.