Stroke Intervention: Geographic Disparities in Acute Stroke Care and the Role of Interventional Cardiology

Abstract

Stroke is the second-leading cause of death and a major cause of disability worldwide. The majority of strokes are ischaemic, and effective therapy to achieve reperfusion includes intravenous thrombolysis and, for proximal large vessel occlusion strokes, endovascular mechanical thrombectomy (MT). There has been a paradigm shift in acute stroke care, driven by a series of randomised controlled trials demonstrating that timely reperfusion with MT results in superior outcomes compared to intravenous thrombolysis in patients with large vessel occlusion strokes. There are significant geographic disparities in delivering acute stroke care because of the maldistribution of neurointerventional specialists. There are now several case series demonstrating the feasibility and safety of first medical contact MT by carotid stent-capable interventional cardiologists and noninvasive neurologists working on stroke teams, which is a solution to the uneven distribution of neurointerventionalists and allows stroke interventions to be delivered in local communities.