EAN 2025 | Disparities in access to reperfusion therapies for stroke across Europe

We have been collecting information for the past years on the delivery of, especially stroke care, intravenous thrombolysis and endovascular treatments. And indeed concerning the reperfusion treatments, so intravenous thrombolysis and endovascular treatments for ischemic stroke with large vessel occlusion, we do know that there are very important disparities across Europe particularly. Also it’s important to note that we in this analysis we always consider Europe according to the World Health Organization definition. So it’s a broad definition of Europe including also some Central Asian countries and Israel. And if we analyze indeed the rates of treatment either per million population or ischemic stroke patients per year, so the proportion of patients treated, let’s say, then we do see that there are major differences across countries that are very difficult to explain only on the basis of having differences in terms of the stroke characteristics. So it has to be also related with capacity and delivery and access to these treatments in the countries. Because we do see countries that have rates of, for example, intravenous thrombolysis that are below 2% and then countries that have more than 20%, even 30% in recent estimates for some European countries. And then the same for endovascular treatment, we have been seeing an improvement across the years. So we did this first analysis back in 2017, analyzing rates for 2016, and we repeated for 2019 and 2020. And now we already have in the stroke service tracker rates for 2023. And we can see improvements in the proportion of patients treated, for example, especially with endovascular treatments, countries like the UK, some South European countries with important improvements in the proportion, in the increase in the proportion of patients treated. But still we can see that especially Eastern European countries and also some South European countries have low rates and also the UK. Some countries started endovascular treatment in between this period, for example Iceland and other countries, but still the rates are not as high as countries, especially in Central Europe for endovascular treatment and especially in Scandinavia and north of Europe for intravenous thrombolysis, countries that have very high rates of treatment. This probably has also to do with specificities of the countries in terms of both intravenous thrombolysis and endovascular treatment. So we could see for intravenous thrombolysis that countries that have very strong networks of stroke units, for example Scandinavian countries, Central Europe, Germany, Switzerland, countries that have a good network of stroke units, they tend to have better rates of intravenous thrombolysis and also especially in the beginning countries that had already in place systems for comprehensive stroke units providing endovascular treatment then they were they were able to you know keep up with giving more treatments in terms of mechanical thrombectomy in their countries while countries where these treatments were not in place before had more delays more often delays in organizing this kind of treatment. But overall the strong message is that there are very important disparities, so countries that have very, very low rates, below 2%, and countries that have more than 10% patients treated with endovascular treatment, more than 30% patients treated with intravenous thrombolysis. So we do have to learn with each other, we do have to monitor these numbers very closely, We have to work with each country in order to understand what are the obstacles and the barriers to the implementation of these treatments. For that reason, we have the collaboration between ESO and SAFE on the Stroke Action Plan and the Stroke Action Plan for Europe Implementation Committee, which has a connection with representatives for all these countries. The goal is really to work together and understanding the specificities of each country and what can be done in terms of advocacy and in terms of collecting data and understanding exactly what are the gaps in infrastructure and technology and policy, prioritization, reimbursement, professional education and other types of workforce shortage. Also improving workflows, improving the detection of large vessel occlusions and very important also and that really has to be done very often to do public awareness campaigns, so to improve public awareness and also the emergency services response so that patients can get to the hospital very quickly. So I think all of this is things that are very important, but of course this has to be tailored to the specificities of each country and that’s why we have connections with all countries and we try to work also with the national stakeholders.

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