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.
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JA and MW are joint first authors.
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.
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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.
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