Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study
Authors: Asif Kaiz S. , Otite Fadar O. , Desai Shashvat M. , Herial Nabeel , Inoa Violiza , Al-Mufti Fawaz , Jadhav Ashutosh P. , Dmytriw Adam A. , Castonguay Alicia , Khandelwal Priyank , Potter-Vig Jennifer , Szeder Viktor , Kulman Tanzila , Urrutia Victor , Masoud Hesham , Toth Gabor , Limaye Kaustubh , Aroor Sushanth , Brinjikji Waleed , Rai Ansaar , Pandian Jeyaraj , Gebreyohanns Mehari , Leung Thomas , Mansour Ossama , Demchuk Andrew M. , Huded Vikram , Martins Sheila , Zaidat Osama , Huo Xiaochuan , Campbell Bruce , Sylaja P.N. , Miao Zhongrong , Saver Jeffrey , Ortega-Gutierrez Santiago , Yavagal Dileep R. , Cirio Juan Jose , Lylyk Pedro , Ferrario Angel , Plaghos Luis Lemme , Arroyo José , Yan Bernard , Chandra Ronil , Ibrahim Wael Hamed , Alnidawi Firas , Islam Sirajee Shafiqul , Shahidullah Mohammad , Saavedra Víctor Villarroel , Alverne Francisco JosÃ Mont’ , Magalhaes Pedro , Silva Gisele Sampaio , Sirakov Stanimir , Kalpachki Rosen , Alioski Nurfet , lamou Eric Gueumekane bila , Shankar Jai , Stotts Grant , Rowe Daidre , Gayle Francene , de Souza Romnesh , Ramos Cristina , GarcÃa Amaury , Ali Amza , Sandy Sherry , Lavados Pablo M. , Rivera Rodrigo , GUZMÁN TONY FABIÁN ÁLVAREZ , Villarraga Alejandro , Estrada Carolina , Pabon Boris , Krajina Antonin , Tomek Aleš , Adebayo Philip B , ABDO GERMAN , Maldonado S Nelson , Hassan Farouk , Khedr Eman M , Khinikadze Mirza , NADAREISHVILI ZURAB , Tsiskaridze Alexander , Syrmos Nikolaos , Mitsias Panayiotis , Das Biplab , Roy Jayanta , Gupta Vivek , Gupta Vipul , Khurana Dheeraj , Karapurkar Anil , Stivastava M.V.Padma , Alurkar Anand , Sharma Arvind , Lahoti Satish , Kumar Rahul , Kuruttukulam Gigy Varkey , Sani Achmad Firdaus , Sari Ita Muharram , Khassaf Mustafa , Majid Nassir Temeem , Sakai Nobuyuki , Yamagami Hiroshi , Dababneh Haitham , Aladham Farid A. , Berdikhojayev Mynzhylky , Medukhanova Sabina , Kikano Raghid , Alaraj Ali , Ahdab Rechdi , Zaidi Wan Asyraf Wan , Kadir Khairul Azmi Abd , Arauz Antonio , Gongora Fernando , Jambaldorj Ariunaa , XXX Ganbaatar , Shwe Zarni Myint , Thit Win Min , Ranta Anna , Wu Teddy , RAYO ERWIN E. , Owolabi Mayowa , Makanjuola Akintomiwa , Ahmad Saima , WASAY MOHAMMAD , Rashid Umair , Mernes Ricardo , Paniagua Osvaldo , GALLO MARLA , Moquillaza Manuel , Collantes Maria Epifania , Mariano Manuel M. , Kobayashi Adam , Rodriguez-Mercado Rafael , Guardia Rodolfo Alcedo , Imam Yahia , Ahmed Ayman Zakaria , Alhazzani Adel , Al-Jehani Hosam M. , Lee Wickly , ZELEŇÁK Kamil , Klepanec Andrej , KRASTEV GEORGI , Frol Senta , Brey Naeem , Rossouw Anastasia , De Silva Prasad , Gunasekera Harsha , Ranawaka Udaya , Osman Haytham , El-Sadig Sarah M , Suwanwela Nijasri C. , Akarathanawat Wasan , Tantivatana Jarturon , Hammami Nadia , Sassi Samia Ben , Ozdemir Atilla Ozcan , Giray Semih , Lebedynets Dmytro , Konotopchik Stanislav , John Seby , Hussain Syed Irteza , Novakovic-White Robin , Ozdemir Atilla Ozcan , Giray Semih , Gordon Perue Gillian L. , Then Ryna , Berrutti Claudio , Crosa Roberto , Nguyen Huy Thang , Le Huynh Vu , vu Tran thanh 
Published: March 2023

Background:
Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale.

Methods:
Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA.

Results:
We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was <1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower–middle versus high: odds ratio, 0.08 [95% CI, 0.04–0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07–5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84–4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70–9.42]) were significantly associated with increased odds of MTA.

Conclusions:
Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.