Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal
Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular...
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| Format: | Article |
| Language: | English |
| Published: |
Ordem dos Médicos
2022-02-01
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| Series: | Acta Médica Portuguesa |
| Subjects: | |
| Online Access: | https://actamedicaportuguesa.com/revista/index.php/amp/article/view/15031 |
| _version_ | 1828140361349857280 |
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| author | Mariana Carvalho Dias Ricardo Soares dos Reis João Vasco Santos Ana Paiva Nunes Patricia Ferreira Bruno Maia Isabel Fragata Joao Reis Joana Ramos Lopes Luis Cruz Gustavo Santo Egidio Machado Denis Gabriel Rui Felgueiras Hugo Mota Dória Angelo Carneiro Manuel Correia Luis Miguel Veloso Pedro Barros Tiago Gregorio Andreia Carvalho Manuel Ribeiro Pedro Teotonio Lia Neto Teresa Pinho e Melo Patricia Canhao João Pedro Filipe Goreti Moreira Elsa Azevedo Maria Luis Silva Elisa Campos Costa Guilherme Oliveira Liliana Pereira Ligia Neves Miguel Rodrigues João Pedro Marto Sofia Calado Fatima Grenho Gabriel Branco Tiago Baptista Jaime Rocha Carla Ferreira Joao Pinho José Manuel Amorim José Manuel Araujo Rui Manuel Neiva João Viana Mariana Lobo Alberto Freitas Vitor Tedim Cruz João Sargento-Freitas José Castro Lopes |
| author_facet | Mariana Carvalho Dias Ricardo Soares dos Reis João Vasco Santos Ana Paiva Nunes Patricia Ferreira Bruno Maia Isabel Fragata Joao Reis Joana Ramos Lopes Luis Cruz Gustavo Santo Egidio Machado Denis Gabriel Rui Felgueiras Hugo Mota Dória Angelo Carneiro Manuel Correia Luis Miguel Veloso Pedro Barros Tiago Gregorio Andreia Carvalho Manuel Ribeiro Pedro Teotonio Lia Neto Teresa Pinho e Melo Patricia Canhao João Pedro Filipe Goreti Moreira Elsa Azevedo Maria Luis Silva Elisa Campos Costa Guilherme Oliveira Liliana Pereira Ligia Neves Miguel Rodrigues João Pedro Marto Sofia Calado Fatima Grenho Gabriel Branco Tiago Baptista Jaime Rocha Carla Ferreira Joao Pinho José Manuel Amorim José Manuel Araujo Rui Manuel Neiva João Viana Mariana Lobo Alberto Freitas Vitor Tedim Cruz João Sargento-Freitas José Castro Lopes |
| author_sort | Mariana Carvalho Dias |
| collection | DOAJ |
| description |
Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts.
Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture.
Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity.
Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.
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| first_indexed | 2024-04-11T19:08:06Z |
| format | Article |
| id | doaj.art-0da282b40c6749e3b645e897c0447e2a |
| institution | Directory Open Access Journal |
| issn | 0870-399X 1646-0758 |
| language | English |
| last_indexed | 2024-04-11T19:08:06Z |
| publishDate | 2022-02-01 |
| publisher | Ordem dos Médicos |
| record_format | Article |
| series | Acta Médica Portuguesa |
| spelling | doaj.art-0da282b40c6749e3b645e897c0447e2a2022-12-22T04:07:41ZengOrdem dos MédicosActa Médica Portuguesa0870-399X1646-07582022-02-0135210.20344/amp.150315391Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in PortugalMariana Carvalho Dias0Ricardo Soares dos Reis1João Vasco Santos2Ana Paiva Nunes3Patricia Ferreira4Bruno Maia5Isabel Fragata6Joao Reis7Joana Ramos Lopes8Luis Cruz9Gustavo Santo10Egidio Machado11Denis Gabriel12Rui Felgueiras13Hugo Mota Dória14Angelo Carneiro15Manuel Correia16Luis Miguel Veloso17Pedro Barros18Tiago Gregorio19Andreia Carvalho20Manuel Ribeiro21Pedro Teotonio22Lia Neto23Teresa Pinho e Melo24Patricia Canhao25João Pedro Filipe26Goreti Moreira27Elsa Azevedo28Maria Luis Silva29Elisa Campos Costa30Guilherme Oliveira31Liliana Pereira32Ligia Neves33Miguel Rodrigues34João Pedro Marto35Sofia Calado36Fatima Grenho37Gabriel Branco38Tiago Baptista39Jaime Rocha40Carla Ferreira41Joao Pinho42José Manuel Amorim43José Manuel Araujo44Rui Manuel Neiva45João Viana46Mariana Lobo47Alberto Freitas48Vitor Tedim Cruz49João Sargento-Freitas50José Castro Lopes51* Co-first author Serviço de Neurologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Departamento de Neurologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa.* Co-first author Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Departamento de Neurologia. Faculty of Medicine. University of Porto. Porto.Departamento de Neurologia. Faculty of Medicine. University of Porto. Porto. Centro de Investigação em Tecnologias e Serviços de Saúde. Porto. Public Health Unit. Agrupamentos de Centro de Saúde Grande Porto VIII. Espinho-Gaia. Administração Regional do Norte. Porto.Unidade Cerebro-vascular. Centro Hospitalar Universitário de Lisboa Central. Lisboa.Unidade Cerebro-vascular. Centro Hospitalar Universitário de Lisboa Central. Lisboa.Unidade Cerebro-vascular. Centro Hospitalar Universitário de Lisboa Central. Lisboa.Serviço de Neurorradiologia. Centro Hospitalar Universitário de Lisboa Central. Lisboa. 9. NOVA Medical School. Universidade Nova de Lisboa. Lisboa.Serviço de Neurorradiologia. Centro Hospitalar Universitário de Lisboa Central. Lisboa.Serviço de Neurologia. Centro Hospitalar Universitário de Coimbra. Coimbra.Serviço de Imagem Médica. Centro Hospitalar Universitário de Coimbra. Coimbra.Serviço de Neurologia. Centro Hospitalar Universitário de Coimbra. Coimbra.Serviço de Imagem Médica. Centro Hospitalar Universitário de Coimbra. Coimbra.Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurorradiologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurorradiologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.Serviço de Neurologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.Serviço de Neurologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.Serviço de Neurologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.Serviço de Neurologia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Vila Nova de Gaia.Serviço de Imagiologia Neurológica. Centro Hospitalar Universitário Lisboa Norte. Lisboa.Departamento de Neurologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Serviço de Imagiologia Neurológica. Centro Hospitalar Universitário Lisboa Norte. Lisboa.Serviço de Neurologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Departamento de Neurologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa.Serviço de Neurologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Departamento de Neurologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa.Serviço de Neurorradiologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Medicina Interna. Centro Hospitalar Universitário de São João. Porto.Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Departamento de Neurologia. Faculty of Medicine. University of Porto. Porto.Serviço de Neurorradiologia. Centro Hospitalar Universitário do Porto. Porto.Serviço de Neurologia. Hospital Garcia de Orta. Almada.Serviço de Neurorradiologia. Hospital Garcia de Orta. Almada.Serviço de Neurologia. Hospital Garcia de Orta. Almada.Serviço de Neurorradiologia. Hospital Garcia de Orta. Almada.Serviço de Neurologia. Hospital Garcia de Orta. Almada.Serviço de Neurologia. Centro Hospitalar de Lisboa Ocidental. Lisboa.Serviço de Neurologia. Centro Hospitalar de Lisboa Ocidental. Lisboa.Serviço de Medicina Interna. Centro Hospitalar de Lisboa Ocidental. Lisboa.Serviço de Neurorradiologia. Centro Hospitalar de Lisboa Ocidental. Lisboa.Serviço de Neurorradiologia. Centro Hospitalar de Lisboa Ocidental. Lisboa.Serviço de Neurorradiologia. Hospital de Braga. Braga.Serviço de Neurologia. Hospital de Braga. Braga.Serviço de Neurologia. Hospital de Braga. Braga. Department of Neurology. University Hospital RWTH Aachen. Aachen. Germany.Serviço de Neurologia. Hospital de Braga. Braga.Serviço de Neurologia. Hospital de Braga. Braga.Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Centro de Investigação em Tecnologias e Serviços de Saúde. Porto.Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Centro de Investigação em Tecnologias e Serviços de Saúde. Porto.Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Centro de Investigação em Tecnologias e Serviços de Saúde. Porto.Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto. Centro de Investigação em Tecnologias e Serviços de Saúde. Porto.Serviço de Neurologia. Hospital Pedro Hispano. Unidade Local de Saúde de Matosinhos. Matosinhos.Serviço de Neurologia. Centro Hospitalar Universitário de Coimbra. Coimbra. Departamento de Neurologia. Faculdade de Medicina. Universidade de Coimbra. Coimbra.Sociedade Portuguesa do AVC. Lisboa. Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals. https://actamedicaportuguesa.com/revista/index.php/amp/article/view/15031Endovascular ProceduresIschemic StrokeMechanical ThrombolysisPortugalThrombectomy |
| spellingShingle | Mariana Carvalho Dias Ricardo Soares dos Reis João Vasco Santos Ana Paiva Nunes Patricia Ferreira Bruno Maia Isabel Fragata Joao Reis Joana Ramos Lopes Luis Cruz Gustavo Santo Egidio Machado Denis Gabriel Rui Felgueiras Hugo Mota Dória Angelo Carneiro Manuel Correia Luis Miguel Veloso Pedro Barros Tiago Gregorio Andreia Carvalho Manuel Ribeiro Pedro Teotonio Lia Neto Teresa Pinho e Melo Patricia Canhao João Pedro Filipe Goreti Moreira Elsa Azevedo Maria Luis Silva Elisa Campos Costa Guilherme Oliveira Liliana Pereira Ligia Neves Miguel Rodrigues João Pedro Marto Sofia Calado Fatima Grenho Gabriel Branco Tiago Baptista Jaime Rocha Carla Ferreira Joao Pinho José Manuel Amorim José Manuel Araujo Rui Manuel Neiva João Viana Mariana Lobo Alberto Freitas Vitor Tedim Cruz João Sargento-Freitas José Castro Lopes Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal Acta Médica Portuguesa Endovascular Procedures Ischemic Stroke Mechanical Thrombolysis Portugal Thrombectomy |
| title | Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal |
| title_full | Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal |
| title_fullStr | Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal |
| title_full_unstemmed | Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal |
| title_short | Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal |
| title_sort | nationwide access to endovascular treatment for acute ischemic stroke in portugal |
| topic | Endovascular Procedures Ischemic Stroke Mechanical Thrombolysis Portugal Thrombectomy |
| url | https://actamedicaportuguesa.com/revista/index.php/amp/article/view/15031 |
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