Abstract 92: Endovascular Thrombectomy Access in the United States: the Current Status and an Optimization Model

Background: Endovascular therapy (EVT) is established for acute ischemic strokes (AIS) with large vessel occlusion (LVO). Timely direct access to EVT-capable centers is integral for EVT utilization and success. We describe and map current EVT access then utilize modeling to optimize it. Methods: US designated stroke centers were identified and mapped utilizing geo-mapping. Centers were stratified into EVT or non-EVT if they reported ≥1 thrombectomy code for AIS in 2016 to Centers for Medicare and Medicaid Service. Ground and air transportation times (30, 60 and 90 min) to EVT centers were calculated from validated trauma models previously adapted for stroke. An optimization model utilizing a greedy algorithm was employed to maximize population ground access within 60 min, as the standard “golden hour” for patients. Ground transport was utilized over air given current transport practices for stroke. A second optimization was done for 30 minutes to give LVOs the best chance to be taken directly to EVT centers, increasing probability of good outcomes. Results: 1645 stroke centers were identified (577 were EVT capable). Approximately 137 million/44%, 195 million/63%, 234 million/76% Americans had 30, 60 and 90 min EVT ground access ; leaving 37% of the population beyond 60 min driving distance to EVT centers. 172 million/56%, 268 million/87%, 296 million/96% of the Americans have air access within 30, 60 and 90 mins. 50 hospitals were identified for “flipping” from non-EVT to EVT, which improved 60 min ground access from 63% to 71% giving access to almost 20 million more Americans. 50 hospitals were flipped to improve the 30 min ground access from 44% to 49%, increasing the coverage by 15 million. Figure 1 shows the current and optimized EVT access map. Conclusion: Only 2/3 of the US population has direct access to EVT within an hour. State and national Efforts should focus on improving access and shorten times to EVT to give patients the best chance for excellent outcome after large strokes.