ESOC 2025 | Improving perfusion treatment rates in underserved stroke populations

This is the talk that was included in the session which was planned together with the WHO. This session was dedicated to management and implementation of stroke treatments. This particular talk was on how can we improve treatment rates for perfusion treatments because we know that intravenous thrombolysis and endovascular treatment are extremely important treatments in the acute phase of ischemic stroke. They have very high-quality data on the improvement of outcomes and also they are very cost-effective procedures. Both intravenous thrombolysis and endovascular treatment from the societal point of view really reduce the costs because we are taking people out of disability and mortality, occupational problems, and difficulty in returning to work, social costs. So there are several ways in which not treating patients becomes much more costly to society. And we were discussing that and also on how then can we improve implementation rates, because there is quite a large set of evidence and we are collecting that now at the European Stroke Action Plan, which is an initiative of ESO together with SAFE on implementing what is the Stroke Action Plan for Europe, which is a set of goals and measures that should be taken to improve stroke care for all European citizens. And indeed what we see is that from that data the rates are extremely variable across countries so there are a lot of countries that seem to be underperforming comparing with the countries where the rates of treatment meaning the proportion of patients with ischemic stroke that are treated per year, for example, are much lower than other countries. And this is a sign that probably a lot can be done, both on the population level, so that they know the warning signs and they can access the stroke pathway and receive the correct treatments, but also, of course, on the healthcare side, on being able to provide treatments on the geographical distribution of stroke centers, on the delivery of treatments so they are faster and more effective, and so that a larger population of patients can be eligible and really receive treatments. And what we see is that the rates are indeed much lower than what will be the expected population of eligible patients, both if we consider the high-performing countries and also if we model the data and if we consider the data that is available on how often do we have IVT patients, patients with ischemic stroke that are eligible for IVT and also if we model the current data on how what is the proportion of patients that have a large vessel occlusion that is eligible for endovascular treatment this goes almost 40% of patients with ischemic stroke. And so this means that a lot of efforts should be done so that in all countries, all these eligible patients can receive the treatments because that will mean a very large difference in terms of patients that become disabled, patients that die due to stroke, particularly to ischemic stroke. And we were discussing these goals these targets the data that we have that suggests that indeed a large proportion of patients should be eligible for endovascular treatment should be eligible for intravenous thrombolysis a proportion that is much larger than the proportion that is being treated even in high performing countries and definitely there’s a huge difference if we compare with the less performing countries. So this was the conclusion. Also, we should consider that in the future, probably the indications will even increase. It’s possible that patients with low NIHSS, patients that are already a bit disabled, other indications, for example, patients that have DOACs that will maybe become eligible for intravenous thrombolysis if trials like the DUET trial and other trials are positive. So we do need to account that it is probable that we will have more indications in the near future. And also we know from the data that is available, for example, the global burden of diseases data, that also the proportion of patients with ischemic stroke, the numbers will increase in the future because of the aging of the population and also increased rates in middle and low-income countries. So we should be aware of this and we should prepare the stakeholders in each country should be prepared to provide treatments and all across the countries and to a large number of patients.

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