Sònia Abilleira1,2, Cristian Tebé3,4, Natalia Pérez de la Ossa5, Marc Ribó6, Pere Cardona7, Xabier Urra8, Eva Giralt-Steinhauer9, David Cánovas10, Pol Camps-Renom11, Miquel Gallofré1,2. 1. Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Spain. 2. CIBER Epidemiología y Salud Pública (CIBERESP), Spain. 3. Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain. 4. Faculty of Medicine and Health Sciences, Rovira i Virgili University, Spain. 5. Neurosciences Department, Hospital Germans Trias i Pujol, Spain. 6. Stroke Unit, Hospital Vall d'Hebron, Spain. 7. Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain. 8. Department of Neuroscience, Hospital Clínic, Spain. 9. Department of Neurology, IMIM - Hospital del Mar, Spain. 10. Department of Neurology, Hospital del Parc Taulí, Spain. 11. Department of Neurology, Hospital de Sant Pau, Spain.
Abstract
INTRODUCTION: Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011-2015. PATIENTS AND METHODS: We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). RESULTS: Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4-4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2-7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. DISCUSSION: This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. CONCLUSION: Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.
INTRODUCTION: Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011-2015. PATIENTS AND METHODS: We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). RESULTS: Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4-4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2-7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. DISCUSSION: This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. CONCLUSION: Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
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Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Natalia Pérez de la Ossa; Sònia Abilleira; Laura Dorado; Xabier Urra; Marc Ribó; Pere Cardona; Eva Giralt; Joan Martí-Fàbregas; Francisco Purroy; Joaquín Serena; David Cánovas; Moisés Garcés; Jurek Krupinski; Anna Pellisé; Júlia Saura; Carlos Molina; Antoni Dávalos; Miquel Gallofré Journal: Stroke Date: 2016-03-31 Impact factor: 7.914
Authors: Sònia Abilleira; Pere Cardona; Marc Ribó; Mònica Millán; Víctor Obach; Jaume Roquer; David Cánovas; Joan Martí-Fàbregas; Francisco Rubio; José Alvarez-Sabín; Antoni Dávalos; Angel Chamorro; Maria Angeles de Miquel; Alejandro Tomasello; Carlos Castaño; Juan M Macho; Aida Ribera; Miquel Gallofré Journal: Stroke Date: 2014-03-04 Impact factor: 7.914