Areal differences in the utilization of endovascular therapy for acute ischemic stroke.

Abstract

Endovascular therapy (EVT) is standard care for acute ischemic stroke due to large vessel occlusion, but its availability is limited in areas with long distances. It has also been demonstrated that there are differences in the utilization of thrombectomy related to socioeconomic factors. The aim of this study is to examine regional differences in the utilization of mechanical thrombectomy and outcome within one comprehensive stroke center district in terms of distance and income. This retrospective single-center study included 352 patients with mechanical thrombectomy in Oulu University Hospital catchment area between the years 2015 and 2019. Socioeconomic status was determined according to the income of residential area. Age-adjusted rate was significantly higher in the highest income areas compared to the lowest and middle third areas; 52.29 (95% CI, 42.85-61.72)/100 000 vs. 34.33 (95% CI, 28.14-40.52) vs. 38.03 (95% CI, 31.14-44.92)/100 000 inhabitants/year. The corresponding rates in rural areas were: 73.37 (95% CI, 53.23-93.51) vs. 37.11 (95% CI, 28.66-45.57) vs. 45.44 (95% CI, 34.72-56.16)/100 000 inhabitants/year. In this study, we found significant differences in the utilization of the EVT within one comprehensive stroke center district. These differences are explained by the income and the rurality of the residential area.