Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-06-16 DOI:10.1177/23969873251347098

Johan Wassélius, Emma Hall, Alex Szolics, Fabian Arnberg, Hozan Radhi, Mia von Euler, Per Wester, Teresa Ullberg, Tobias Cronberg, Nicklas Ennab Vogel, Magnus Esbjörnsson, Fredrik Jonsson, Tommy Andersson, Bo Norrving, Björn M Hansen

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引用次数: 0

Abstract

Introduction: Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for procedural and implementational effectiveness.

Methods: A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.

Results: Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%-12.4%, in 2022).

Conclusions: By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.

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瑞典急性缺血性卒中的血管内取栓率存在较大的区域差异。

血管内取栓术（Endovascular thrombectomy， EVT）是急性缺血性卒中（acute ischemic stroke， AIS）患者护理的一项显著改善，但只有一小部分患者接受了治疗。我们的目的是根据程序和实施有效性的一组关键绩效指标（kpi）来分析瑞典EVT的实施情况。方法：一项全国性的前瞻性基于注册的观察性研究，使用2018年、2020年和2022年瑞典卒中护理质量注册中心（Riksstroke和EVAS）和官方人口统计数据的数据。使用一组预定义的kpi来分析有效性。为了在单一的可理解的测量中描述程序和实施的有效性，种群成功率由EVT率乘以成功的再通率得出。结果：2018年至2022年期间，瑞典的evt从每年874例增加到1474例。相应地，EVT率（EVT/AIS）从4.1%上升到7.3%。执行是异质的，在最高和最低的区域之间有六倍的差异。EVT率一般在有综合卒中中心（CSCs）的地区最高。所有CSCs的程序有效性相似。在此期间，人口成功率从3.4%上升到6.4%，CSCs之间的差异很大（范围为3.4%-12.4%，2022年）。结论：通过纳入程序和实施有效性的kpi，可以评估EVT在整个卒中人群中的实施情况，这是医疗保健的最终目标。人口成功率以所有利益攸关方都能理解的单一措施衡量程序实施的有效性，并便于在时间和地区之间进行比较，甚至在卒中发病率不同的地区之间进行比较。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.