Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020
Authors: Aguiar de Sousa Diana , Wilkie Arlene , Norrving Bo , Macey Chris , Bassetti Claudio , Tiu Cristina , Roth Greg , Lunde Grethe , Christensen Hanne , Fiehler Jens , Pezzella Francesca Romana , Dichgans Martin , Roaldsen Melinda B , Kelly Peter , Mikulik Robert , Sacco Simona , Caso Valeria , Fischer Urs , Basha Entela , Yeghiazaryan Nune , Kiechl Stefan , Shiraliyeva Rana , Vanacker Peter , Bender Marija , Emilov Tsalta-Mladenov Mihael , Budincevic Hrvoje , Tomek Ales , Kaponides Georgios , Klingenberg Iversen Helle , Faiss Jürgen , Kõrv Janika , Sairanen Tiina , Igor Sibon , Tsiskaridze Alexander , Ntaios George , Tsivgoulis Georgios , Szapary Laszlo , Logi Thorarinsson Bjorn , Harbison Joe , Bornstein Natan M. , Toni Danilo , Fisnik Jashari , Karbozova Kunduz , Miglane Evija , Dalius Jatužis , Droste Dirk , Mallia Maria , Jevto Erakovic , Arsovska Anita , Fromm Annette , Kobayashi Adam , Azevedo Elsa , Groppa Stanislav , Cristina Tiu , Guekht Alla , Zivanovic Zeljko , Nosal Vladimir , Zvan Bojana , López-Cancio Elena , Pérez de la Ossa Natàlia , Norrving Bo , Nedeltchev Krassen , Vrijhoef Bert , Akif Topcuoglu Mehmet , Flomin Yuriy , Ahmed Rubina , Shelesko Andrey , Petrela Mentor , Zubalova Lina , Hasanov Rovshan , Raedt Sylvie De , Nevena Mahmutbegović , Peteva Andonova Silva , Poljakovic Zdravka , Skoda Ondrej , Søren Paaske Johnsen , med. Helmuth Steinmetz Prof. Dr. , Kõrv Janika , Sairanen Tiina , Denis Sablot , Lobjanidze Nino , Milionis Haralambos , Mitsias Panagiotis , Tarkanyi MD Gabor , Elisabeth Klinke Marianne , Tanne David , Luca Petraglia , Dren Boshnjaku , Turgumbaev Dzhamal , Guntis Karelis , Dalius Jatužis , Droste Dirk , Mladen Debeljevic , Arsovska Anita , Kurz Martin , Anna Czlonkowska , Eremei Zota , Elena Oana Terecoasa , Martinov Mikhail , Jovanović Dejana , Gdovinova Zuzana , Zvan Bojana , López-Cancio Elena , Camps Renom Pol , Kwa Vincent , Murat Arsava Ethem , Gulyayeva Maryna , Dharmasiri Michelle , Basha Entela , Korompoki Eleni , Vadikolias Konstantinos , Bereczki MD Daniel , Bryndis Einarsdottir Anna , Afrim Blyta , Mamytova Elmira , Kristaps Jurjans , Daiva Rastenytė , Costache Oana , Milovan Roganovic , Fromm Annette , Michal Karlinski , Alexandru Gasnas , Sorin Tuta , Fidler Mikhail , Raičević Ranko , Zaletel Marjan , Castellanos Mar , Gómez-Choco Manuel , Sirin Hadiye , Lebedynets Dmytro , Khaira Jattinder , Enesi Eugen , Sahakyan David , Mammadbayli Ayten , Lemmens Robin , Dževdet Smajlović , Emilov Tsalta-Mladenov Mihael , Budincevic Hrvoje , Sramek Martin , Nabavi med. Darius , Vibo Riina , Strbian Daniel , Aliyev Rahim , Mikulik Robert , Ozretic David , Rocek Miloslav , Trine Stavngaard , med. Claus Zimmer Prof. Dr. , Malikov Vladislav , Lappalainen Kimmo , Jerome Berge , Khinikadze Mirza , Brountzos Elias , Vilmarsson Vilhjalmur , Karlis Kupcs , Marius Kurminas , Hoffmann Michel , Grech Reuben , Marija Mitric , Kjellevold Wathle Gaute , Wojciech Poncyljusz , Igor Crivorucica , Bogdan Dorobat , Till Viktor , Klepanec Andrej , Milosevic Zoran , Macho Juan , Ozdemir Ozcan , Shchehlov Dmytro , Dorte Damgaard , Hermanek Peter , Sturua Lela , Siskou Olga , Tsivgoulis Georgios , Libruder Carmit , Indredavik Bent , Azevedo Elsa , Elena Manole , Mijajlović Milija , Turcani Peter , Norrving Bo , Bonati Leo , Nederkoorn Paul , Ertuğrul Eğin Muhammed , Samofalov Dmytro , Diana Ose , Rita Gaidelytė , Droste Dirk 
Published: July 2023

Introduction:

We assessed best available data on access and delivery of acute stroke unit (SU) care, intravenous thrombolysis (IVT) and endovascular treatment (EVT) in the European region in 2019 and 2020.

Patients and methods:

We compared national data per number of inhabitants and per 100 annual incident first-ever ischaemic strokes (AIIS) in 46 countries. Population estimates and ischaemic stroke incidence were based on United Nations data and the Global Burden of Disease Report 2019, respectively.

Results:

The estimated mean number of acute SUs in 2019 was 3.68 (95% CI: 2.90–4.45) per one million inhabitants (MIH) with 7/44 countries having less than one SU per one MIH. The estimated mean annual number of IVTs was 21.03 (95% CI: 15.63–26.43) per 100,000 and 17.14% (95% CI: 12.98–21.30) of the AIIS in 2019, with highest country rates at 79.19 and 52.66%, respectively, and 15 countries delivering less than 10 IVT per 100,000. The estimated mean annual number of EVTs in 2019 was 7.87 (95% CI: 5.96–9.77) per 100,000 and 6.91% (95% CI: 5.15–8.67) of AIIS, with 11 countries delivering less than 1.5 EVT per 100,000. Rates of SUs, IVT and EVT were stable in 2020. There was an increase in mean rates of SUs, IVT and EVT compared to similar data from 2016.

Conclusion:

Although there was an increase in reperfusion treatment rates in many countries between 2016 and 2019, this was halted in 2020. There are persistent major inequalities in acute stroke treatment in the European region. Tailored strategies directed to the most vulnerable regions should be prioritised.