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Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden

Wassélius, Johan LU ; Hall, Emma LU orcid ; Szolics, Alex ; Arnberg, Fabian ; Radhi, Hozan ; von Euler, Mia ; Wester, Per ; Ullberg, Teresa LU ; Cronberg, Tobias LU and Ennab Vogel, Nicklas , et al. (2025) In European Stroke Journal
Abstract

INTRODUCTION: Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for
procedural and
implementational effectiveness.

METHODS: A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population... (More)

INTRODUCTION: Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for
procedural and
implementational effectiveness.

METHODS: A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.

RESULTS: Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%-12.4%, in 2022).

CONCLUSIONS: By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Stroke Journal
publisher
SAGE Publications
external identifiers
  • pmid:40524387
  • scopus:105009748856
ISSN
2396-9881
DOI
10.1177/23969873251347098
language
English
LU publication?
yes
id
18f50086-f643-4ab8-97e9-0eba78b92e5f
date added to LUP
2025-08-30 11:01:20
date last changed
2025-09-28 08:10:18
@article{18f50086-f643-4ab8-97e9-0eba78b92e5f,
  abstract     = {{<p>INTRODUCTION: Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for <br>
 procedural and <br>
 implementational effectiveness.<br>
 </p><p>METHODS: A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.</p><p>RESULTS: Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%-12.4%, in 2022).</p><p>CONCLUSIONS: By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.</p>}},
  author       = {{Wassélius, Johan and Hall, Emma and Szolics, Alex and Arnberg, Fabian and Radhi, Hozan and von Euler, Mia and Wester, Per and Ullberg, Teresa and Cronberg, Tobias and Ennab Vogel, Nicklas and Esbjörnsson, Magnus and Jonsson, Fredrik and Andersson, Tommy and Norrving, Bo and Hansen, Björn M}},
  issn         = {{2396-9881}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{SAGE Publications}},
  series       = {{European Stroke Journal}},
  title        = {{Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden}},
  url          = {{http://dx.doi.org/10.1177/23969873251347098}},
  doi          = {{10.1177/23969873251347098}},
  year         = {{2025}},
}