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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

Prehospital stroke code activation results in reduced pre- and in-hospital delays and triage and transport of stroke patients to the right centers. In Paraguay, data about acute reper fusion treatment are not available. Recently, a pilot prehospital stroke code program was implemented in the country in November 2016. In an observational, single-center cohort study with a before–after design, from April 2015 to July 2018, we found that 193/832 (23.1%) of stroke patients were stroke code activated, and from these, 54 (6.5%) were brought to hospital under the prehospital stroke code protocol. Fifty-eight patients (58 alteplase and 2 additional endovascular treatment) received reperfusion therapy. Prehospital stroke code patients had a lower mean door-to-CT time (24 vs. 33 min, p = 0.021) and lower mean door-to-needle time (35.3 vs.76.3 min, p

Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods and Results Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short‐term follow‐up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in‐hospital stay of 8 days (interquartile range, 5–8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outcome (modified Rankin scale, 3–6) was present in 1662 (34.7%) patients and 38.2% of women ( P P =0.01). Death and poor functional outcome for all‐type stroke showed a higher risk in female patients (hazard ratio, 1.3, P =0.03; and hazard ratio, 1.1, P =0.001, respectively). Conclusions A worse functional outcome and higher mortality rates occurred in women compared with men in the LASE , confirming sex differences issues at short‐term follow‐up.

Information about clinical outcome and reperfusion treatment in Latin-America is not widely known. Our aim was to determine this association and other clinical factors according to the initial clinical severity in functional outcome in the population from the Latin-America Stroke Registry (LASE). Methods: Data were collected prospectively from consecutive patients admitted from January 2012-January 2017 in 20 Latin-American centers. The initial clinical severity was stratified according to the baseline NIHSS; 0-3 minor, 4-7 mild, 8-14 moderate, and ≥15 severe. Clinical outcome was defined by mRS at 3 months, dichotomized in good (0-2) and poor (3-6) groups for univariate and logistic multivariate analysis. Results: Among 5381 patients, 823(15.3%) patients received any reperfusion treatment. Of these, 84.7% received I.V. fibrinolytic, 13.2% bridging therapy, and 0.9 % primary endovascular treatment. In overall, according to initial clinical deficit by NIHSS, reperfusion treatment was associated with good outcome in mild (82.8% Vs 66.1% p=0.005), moderate (55.9 % vs. 41.6% p=0.002) and severe deficits (29.4 Vs. 18.8% p=0.002). In patients with a baseline NIHSS ≥4, multivariate analysis showed that lower NIHSS (p Conclusion: In this study, the rate of reperfusion treatment in 20 stroke Latin-American centers is lower than that reported from other world regions. A significant association between reperfusion treatment and good clinical outcome was observed in mild up to severe baseline deficit in our study. The effect of ischemic cardiopathy in clinical outcome in reperfusion treated patients deserves further studies. Its association with recanalization, remote pre-conditioning ischemia and collateral circulation could be explored in our population.