Defining optimal thrombectomy-per-ischemic-stroke targets: a methodology for guiding procedure volumes per center in France

Background and purpose

Mechanical thrombectomy (MT) has emerged as a groundbreaking treatment for large vessel occlusion strokes. There is limited data on the expected number of thrombectomies based on regional demographics, the ideal proximity to thrombectomy centers for the population, and the appropriate thrombectomy-per-ischemic-stroke ratio centers should target.

Materials and methods

This retrospective analysis (2018–2024) used data from the French National Uniform Hospital Discharge Dataset to establish benchmark indicators guiding public health policy. We defined the Thrombectomy Target Level (TTL) as the median standardized thrombectomy-per-ischemic-stroke ratio and the Thrombectomy Alert Level (TAL) as the 25th percentile of the standardized thrombectomy-per-stroke ratio across all administrative regions. These thresholds were calculated annually, and percentages were mapped. Using the TTL and the distribution of thrombectomy-treated stroke cases as a function of distance, we determined the maximum car travel time to achieve this goal.

Results

Over the study period, 803,058 strokes and 49,154 thrombectomies (6.1 % of all strokes) were reported in the PMSI. TTL rose from 4.4 % in 2018 to 7.0 % in 2024 and TAL rose from 3.6 % to 5.6 %. The geographic distribution of standardized thrombectomy-per-ischemic-stroke ratio revealed disparities in thrombectomy treatment levels across regions. To meet TTL objectives, the population should be within 50 min by car from a thrombectomy center.

Conclusion

We set epidemiological thresholds as targets (TTL) and alerts (TAL) to identify regions performing insufficient thrombectomies. Public health authorities can use these thresholds to adjust and optimize healthcare services. For optimal access, the population should be within an hour’s drive from a center.