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

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. We have featured as our Editor’s Pick for Interventional Cardiology 8.1 this discussion by White et al. of disparities in acute stroke care delivery due to regional service differences. Randomised studies in acute ischaemic stroke have demonstrated the superiority of mechanical thrombectomy over systemic thrombolysis in achieving reperfusion of large vessel occlusion. For more than four decades, interventional cardiologists have accumulated experience in treating acute coronary syndromes, and integration into stroke teams may help to achieve timely reperfusion and solve the disparities in access to specialised stroke centres, as shown in this article. Authors: *Christopher J. White, Jose D. Tafur, Tamunoinemi Bob-Manuel, Marloe Prince, Rajan A.G. Patel, J. Stephen Jenkins, Tyrone J. Collins, Stephen R. Ramee Ochsner Medical Center, New Orleans, Louisiana, USA *Correspondence to cwhite@ochsner.org Disclosure: The authors have declared no conflicts of interest.