Stroke is one of the leading causes of disability and the fourth leading cause of death. Of all stroke types, stroke due to large vessel occlusion (LVO; essentially, a clot in a big blood vessel to the brain) causes approximately 60% of post-stroke dependence and death. Until 2015, the only evidence-based therapy for LVO stroke was thrombolysis with intravenous alteplase, which results in recanalization of the vessel in approximately 4-30% of cases depending on site of occlusion. This situation changed substantially in 2015, when five randomized trials demonstrated superiority of endovascular therapy (ET; essentially, mechanical removal of clot) for confirmed LVO. Even though ET has the greatest benefit of all acute stroke therapies, access is limited to a minority of US centers with adequate resources and expertise. Data suggest underutilization of ET nationwide, with signification variation and inequity throughout the country. This study will identify geographic variation in endovascular therapy for LVO stroke, which likely worsens disparities and inequities vulnerable populations such as racial minorities and socioeconomically disadvantaged populations already face. Additionally, it will examine utilization of resources and processes associated with optimal LVO stroke care nationally. The hope is develop a deeper understanding about ET to develop targeted regional solutions to inform the future of more equitable acute stroke systems of care. The proposed study aims are to identify: (1) Geographic variation in ET utilization and (2) Resources and processes facilitating and impeding ET utilization across the United States. The findings from this award will inform evolving stroke systems of care as well as an R01 to test the impact of a regional solution to address factors resulting in geographic disparities in ET for LVO stroke. Importantly, I hope this work will contribute to the AHA/American Stroke Association goal of increasing national and global healthy life expectancy equitably by 2030. Where one has a stroke should not impact the care one gets.
|Effective start/end date||1/07/21 → 30/06/24|
- American Heart Association: $231,000.00