Please use this identifier to cite or link to this item: http://hdl.handle.net/10316/103547
Title: Nationwide Access to Endovascular Treatment for Acute Ischemic Stroke in Portugal
Other Titles: Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal
Authors: Dias, Mariana Carvalho
Reis, Ricardo Soares dos
Santos, João Vasco
Nunes, Ana Paiva
Ferreira, Patricia
Maia, Bruno
Fragata, Isabel
Reis, Joao
Lopes, Joana Ramos
Cruz, Luis
Santo, Gustavo
Machado, Egidio
Gabriel, Denis
Felgueiras, Rui
Dória, Hugo Mota
Carneiro, Angelo
Correia, Manuel 
Veloso, Luis Miguel
Barros, Pedro
Gregorio, Tiago
Carvalho, Andreia
Ribeiro, Manuel
Teotonio, Pedro
Neto, Lia
Melo, Teresa Pinho e
Canhao, Patricia
Filipe, João Pedro 
Moreira, Goreti
Azevedo, Elsa
Silva, Maria Luis
Costa, Elisa Campos
Oliveira, Guilherme
Pereira, Liliana
Neves, Ligia
Rodrigues, Miguel
Marto, João Pedro
Calado, Sofia
Grenho, Fatima
Branco, Gabriel
Baptista, Tiago 
Rocha, Jaime
Ferreira, Carla
Pinho, João 
Amorim, José Manuel
Araújo, José Manuel 
Neiva, Rui Manuel
Viana, João 
Lobo, Mariana
Freitas, Alberto
Cruz, Vitor Tedim
Sargento-Freitas, João 
Lopes, José Castro
Keywords: Endovascular Procedures; Ischemic Stroke; Mechanical Thrombolysis; Portugal; Thrombectomy; Acidente Vascular Cerebral Isquémico; Portugal; Procedimentos Endovasculares; Trombólise Mecânica; Trombectomia
Issue Date: 1-Feb-2022
Project: Grant from Sociedade Portuguesa do Acidente Vascular Cerebral 
Serial title, monograph or event: Acta Medica Portuguesa
Volume: 35
Issue: 2
Abstract: 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.
Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto.
URI: http://hdl.handle.net/10316/103547
ISSN: 1646-0758
0870-399X
DOI: 10.20344/amp.15031
Rights: openAccess
Appears in Collections:FMUC Medicina - Artigos em Revistas Nacionais

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