ESOC 2025 | Global disparities in thrombectomy access for LVO stroke: challenges and solutions

This talk allowed me to explain and share the current status of access to thrombectomy for large vessel occlusion stroke on a global level. As the founder and global chair emeritus of Mission Thrombectomy, we’ve been working on the challenges to access for thrombectomy since the last nine years and what we found is that the access to this very powerful and beneficial treatment is devastatingly low. The MT-GLASS study that we conducted in 2019 was the first ever to calculate what the access rate to thrombectomy is on a global level and how it varies between countries, and we found that the global median access is only 2.79% and the disparity in access is almost 500-fold between the highest access country and the lowest access country, which in the MT-GLASS study are Australia and Bangladesh. For a brain-saving, life-saving therapy, this is highly unacceptable, but I think this is a fact that’s not really well known, that how inequitable access to this therapy is. And in learning from principles of treatment access, it’s not surprising because new treatments without proactive efforts can take decades to get access to patients at any significant levels. And so that’s why we founded Mission Thrombectomy in 2016 through the Society of Vascular and Interventional Neurorology to pursue public health interventions applied globally at each regional level to increase access in a fast and rapid manner. We’ve had great success by following these guiding principles where you overcome three main barriers of access to any treatment, which can be applied to thrombectomy also. The first is the information barrier about what is a large vessel occlusion stroke, how is it to be triaged. The second barrier is the physical barrier, the infrastructure for thrombectomy and the operators for thrombectomy, that’s the physical barrier. And the last is the financial barrier where there has to be an upfront investment by governments, by hospitals, but also continued reimbursement. And so devising public health interventions which are more top-down through advocacy, through public education, and through technology. We work with regional committees in each country to devise and implement these interventions. One of the interventions we have done, which has been very successful, is a white paper for policymakers that we wrote in policymaker language where we talked about building thrombectomy systems of care in your region, why and how. And that has been translated into over 20 languages, has been released by over 10 health ministries around the world. And that is the kind of public health intervention that needs to be continued and magnified to get more thrombectomy systems of care to be built in countries around the world. There are many other public health interventions, including pre-hospital education for recognizing stroke. And of course, the reimbursement piece where we’ve been again successful in India in increasing reimbursement with the white paper used as an advocacy tool. And I think this work, again, cannot be done alone. We partner with the World Stroke Organization, AHA, American Heart, American Stroke, and many others, including industry, to really take this work forward and achieve our goal in a relatively short time period. So that’s the overview of the talk. And certainly, we are better off than we were nine years ago. But we think there is lots of work to be done probably for another decade, if not more, so that we don’t leave any large vessel occlusion stroke patient behind to either face death or lifelong disability anywhere in the world.

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