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Original research
Mapping access to endovascular stroke care in the USA and implications for transport models
  1. Jared Aldstadt1,
  2. Muhammad Waqas2,3,
  3. Misa Yasumiishi1,
  4. Maxim Mokin4,5,
  5. Vincent M Tutino2,6,
  6. Hamid H Rai7,
  7. Felix Chin7,
  8. Bennett R Levy8,
  9. Ansaar T Rai9,
  10. J Mocco10,
  11. Kenneth V Snyder3,11,
  12. Jason M Davies3,12,
  13. Elad I Levy2,3,
  14. Adnan H Siddiqui2,3
  1. 1National Center for Geographic Information and Analysis and Department of Geography, University at Buffalo - The State University of New York, Buffalo, New York, USA
  2. 2Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  3. 3Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
  4. 4Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA
  5. 5Neurosciences Center, Tampa General Hospital, Tampa, Florida, USA
  6. 6University at Buffalo Canon Stroke and Vascular Research Center, Buffalo, New York, USA
  7. 7Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  8. 8(Medical school student), The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  9. 9Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
  10. 10Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  11. 11Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  12. 12Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  1. Correspondence to Dr Adnan H Siddiqui, Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14214, USA; asiddiqui{at}ubns.com

Abstract

Background The purpose of this cross-sectional study was to determine the percentage of the US population with 60 min ground or air access to accredited or state-designated endovascular-capable stroke centers (ECCs) and non-endovascular capable stroke centers (NECCs) and the percentage of NECCs with an ECC within a 30 min drive.

Methods Stroke centers were identified and classified broadly as ECCs or NECCs. Geographic mapping of stroke centers was performed. The population was divided into census blocks, and their centroids were calculated. Fastest air and ground travel times from centroid to nearest ECC and NECC were estimated.

Results Overall, 49.6% of US residents had 60 min ground access to ECCs. Approximately 37.7% (113 million) lack 60 min ground or air access to ECCs. Approximately 84.4% have 60 min access to NECCs. Ground-only access was available to 77.9%. Approximately 738 NECCs (45.4%) had an ECC within a 30 min drive.

Conclusion Nearly one-third of the US population lacks 60 min access to endovascular stroke care, but this is highly variable. Transport models and planning of additional centers should be tailored to each state depending on location and proximity of existing facilities.

  • stroke
  • thrombectomy
  • economics
  • statistics
  • technology

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Footnotes

  • JA and MW are joint first authors.

  • Twitter @Ansaar_Rai

  • JA and MW contributed equally.

  • Contributors Conception and design: JA, MW, AHS. Data acquisition: MW, FC, ATR, BRL. Data analysis and interpretation: MW, JA, MY. Drafting the manuscript: JA, MW. Critically revising the manuscript: all authors. Final approval of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests The authors report the following relationships, although not directly related to this submission. JMD: Research grant: National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. Consulting: Medtronic; Honoraria: Neurotrauma Science; shareholder/ownership interests: Cerebrotech, RIST Neurovascular. BRL: Shareholder/Ownership interests: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical; National Principal Investigator/Steering Committees: Medtronic (merged with Covidien Neurovascular), SWIFT Prime and SWIFT Direct Trials; Honoraria: Medtronic (training and lectures); Consultant: Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed; Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical, Endostream Medical; Site Principal Investigator: CONFIDENCE study (MicroVention), STRATIS Study—Sub I (Medtronic). MM: Grant support: NIH R21NS109575 (Principal Investigator); Consultant: Medtronic, Canon Medical, Cerenovus;. Stock options: Serenity Medical, Synchron, VICIS, Endostream. JM: Consultant: Penumbra, Cerebrotech, Rebound Therapeutics, Imperative Care (formerly TSP), Lazarus Effect, Medina, Pulsar Vascular, Blockade. ATR: Consultant: Penumbra, MicroVention, Stryker. AHS: Financial interest/investor/stock options/ownership: Adona Medical, Amnis Therapeutics (purchased by Boston Scientific October 2017), Blink TBI, Buffalo Technology Partners, Cerebrotech Medical Systems, Cognition Medical, Endostream Medical, Imperative Care, International Medical Distribution Partners, Neurovascular Diagnostics, Q’Apel Medical, Rebound Therapeutics Corp (purchased 2019 by Integra Lifesciences Corp), Rist Neurovascular, Sense Diagnostics, Serenity Medical, Silk Road Medical, Spinnaker Medical, StimMed, Synchron, Three Rivers Medical, Vastrax, VICIS, Viseon; Consultant/advisory board: Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA, Cerebrotech Medical Systems, Cerenovus, Corindus, Endostream Medical, Imperative Care, Integra LifeSciences Corp, Medtronic, MicroVention, Minnetronix Neuro, Northwest University–DSMB Chair for HEAT Trial, Penumbra, Q’Apel Medical, Rapid Medical, Rebound Therapeutics Corp (purchased by Integra LifeSciences Corp), Serenity Medical, Silk Road Medical, StimMed, Stryker, Three Rivers Medical, VasSol, W L Gore & Associates; Principal investigator/steering committee of the following trials: Cerenovus NAPA and ARISE II; Medtronic SWIFT PRIME and SWIFT DIRECT; MicroVention FRED & CONFIDENCE; MUSC POSITIVE; and Penumbra 3D Separator, COMPASS, INVEST, and TIGER. KVS: Consulting and teaching: Canon Medical Systems Corp, Penumbra, Medtronic, and Jacobs Institute. Co-Founder: Neurovascular Diagnostics.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data that support the findings of this study are available from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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