Abstract P170: Stroke Coordinator Roles and Developmental Needs Around the Globe: An MT2020 International Survey

Background: Stroke Coordinators (SC) are commonly utilized in US Stroke Centers, ensuring provision of evidence-based service, overseeing quality improvement, and supporting interdisciplinary and community education. Mission Thrombectomy 2020 (MT2020) partnered with the Association of Neurovascular Clinicians (ANVC) to understand how SCs are utilized outside the US and to compare developmental needs for this role across the world. Methods: A brief survey was constructed to capture information about the use of SCs and their duties, including personnel utilized to execute the role and areas deemed important for role development. The survey was disseminated through the MT2020 and ANVC membership rosters; returned data were assembled in SPSS (version 25) and analyzed using descriptive and X 2 statistics. Results: A total of 70 surveys were returned from 16 countries (63% USA). Survey responders were SCs (41%), physicians (39%), program managers (19%) and APPs(1%), and 49% were from CSCs/TSCs with 40% PSC and 11% ASR/other hospital; 92% had someone completing SC duties with MDs more commonly in the SC role outside the USA (63%) versus RNs in the USA (95%; X 2 =25.2, p<0.001). Table 1 lists role differences between USA and other countries. Of the 70% of respondents interested in receiving SC development resources, the aspect deemed most important was “Improvement of Stroke Nursing Knowledge/Care” (71% non-USA/81% USA). “Development of Stroke Systems of Care” was deemed second most important by non-USA hospitals (53%), followed by “Development of Government Policy” (35%). Conclusions: Non-USA Stroke Centers have significant SC development needs that differ markedly from those within the USA. MT2020 provides an important platform to engage international programs and the MT2020-ANVC partnership is well positioned to further stroke nursing care and SC development globally

Abstract Number ‐ 203: #BEFASTChallenge: Social Media Dance Campaign for Stroke Symptoms Awareness

Introduction Public stroke education campaigns have traditionally utilized mass media. We hypothesized that a worldwide stroke awareness social media campaign, utilizing dance videos to express the BE‐FAST acronym for stroke signs and symptoms, could reach a large audience at a low cost. Methods Mission Thrombectomy 2020+ officially launched the #BEFASTChallenge, a Social Media (SoMe) public stroke educational campaign, on May 15, 2022, World Stroke Thrombectomy Day, after an internal “lead‐in” phase starting the first week of May 2022. The campaign was volunteer designed and implemented. The public and their followers were encouraged to post a video of their dance depicting each letter of BE‐FAST, tag the post with #BEFASTChallenge, and nominate others to participate. We tracked the SoMe posts from May 4th through July 13, 2022, on Facebook (FB), Twitter (TW), and Instagram (IG) platforms by searching #BEFASTChallenge on each SoMe site. We ascertained campaign adoption, public reach, and interaction by measuring original posts, views, likes, retweets, shares, and comments. Results There were 4 countries represented in the original posts on SoMe with the vast majority being from the US. The first post was on May 4, and the last was on July 13 (71 days), resulting in a daily average of 0.55 posts. The largest number of posts occurred on the launch date (16 posts). There were 39 original posts, which accumulated 170 retweets, 44 quote tweets, 755 likes, 32 comments, and 14 shares. The videos had 13,821views (Table 1). Conclusions We report that the preliminary analysis of a volunteer‐driven SoMe public stroke campaign utilizing dance to express stroke symptoms demonstrates feasibility, reaching a modest audience directly with good interaction. A similar professionally implemented SoMe campaign could lead to increased and more sustained user engagement to raise public stroke symptom awareness

Abstract Number ‐ 203: #BEFASTChallenge: Social Media Dance Campaign for Stroke Symptoms Awareness

Introduction Public stroke education campaigns have traditionally utilized mass media. We hypothesized that a worldwide stroke awareness social media campaign, utilizing dance videos to express the BE‐FAST acronym for stroke signs and symptoms, could reach a large audience at a low cost. Methods Mission Thrombectomy 2020+ officially launched the #BEFASTChallenge, a Social Media (SoMe) public stroke educational campaign, on May 15, 2022, World Stroke Thrombectomy Day, after an internal “lead‐in” phase starting the first week of May 2022. The campaign was volunteer designed and implemented. The public and their followers were encouraged to post a video of their dance depicting each letter of BE‐FAST, tag the post with #BEFASTChallenge, and nominate others to participate. We tracked the SoMe posts from May 4th through July 13, 2022, on Facebook (FB), Twitter (TW), and Instagram (IG) platforms by searching #BEFASTChallenge on each SoMe site. We ascertained campaign adoption, public reach, and interaction by measuring original posts, views, likes, retweets, shares, and comments. Results There were 4 countries represented in the original posts on SoMe with the vast majority being from the US. The first post was on May 4, and the last was on July 13 (71 days), resulting in a daily average of 0.55 posts. The largest number of posts occurred on the launch date (16 posts). There were 39 original posts, which accumulated 170 retweets, 44 quote tweets, 755 likes, 32 comments, and 14 shares. The videos had 13,821views (Table 1). Conclusions We report that the preliminary analysis of a volunteer‐driven SoMe public stroke campaign utilizing dance to express stroke symptoms demonstrates feasibility, reaching a modest audience directly with good interaction. A similar professionally implemented SoMe campaign could lead to increased and more sustained user engagement to raise public stroke symptom awareness

Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention

Abstract P141: Global Impact of Covid-19 Pandemic on Acute Stroke and Mechanical Thrombectomy - An International Survey

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice. Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software. It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 th to May 15 th , 2020. Results: There were 113 responses across 25 countries. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B). This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic. The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferred-intubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS). There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0.6) or if intubation policy was changed in either direction (p=1). Low-volume (20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%). Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic

International Survey of Mechanical Thrombectomy Stroke Systems of Care During COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on various aspects of thrombectomy systems. AIMS: We conducted a convenience electronic survey with a 21-item questionnaire aimed to identify the changes in stroke admission volumes and thrombectomy treatment practices seen during a specified time period of the COVID-19 pandemic. METHODS: The survey was designed using Qualtrics software and sent to stroke and neuro-interventional physicians around the world who are part of the Global Executive Committee (GEC) of Mission Thrombectomy 2020, a global coalition under the aegis of Society of Vascular and Interventional Neurology, between April 5th and May 15th, 2020. RESULTS: There were 113 responses to the survey across 25 countries with a response rate of 31% among the GEC members. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during the COVID-19 pandemic period until May 15th, 2020 compared to pre-pandemic months. The intubation policy for MT procedures during the pandemic was highly variable across participating centers: 44% preferred intubating all patients, including 25% of centers that changed their policy to preferred-intubation (PI) from preferred non-intubation (PNI). On the other hand, 56% centers preferred not intubating patients undergoing MT, which included 27% centers that changed their policy from PI to PNI. There was no significant difference in rate of COVID-19 infection between PI versus PNI centers (p=0.60) or if intubation policy was changed in either direction (p=1.00). Low-volume (/month) compared with high-volume stroke centers (\u3e20 strokes/month) were less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers were more likely to report them to be inadequate (58% vs 92%). CONCLUSION: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic. Overall, respondents reported decreased stroke admissions as well as decreased cases of MT with no clear preponderance in intubation policy during MT

Abstract Number ‐ 109: Mechanical Thrombectomy Hands‐on Skill Workshop for MT2020+ in the Caribbean

Introduction While mechanical thrombectomy (MT) is proven to be lifesaving and disability‐sparing, there remains disparities in access in low‐ to middle‐income countries (LTMICs), including the Caribbean. We hypothesized that team‐oriented MT workshops would improve MT skills and change practice patterns for MT services in this region. Methods We designed a 22‐hour MT workshop which was conducted as two identical events: in English (Jamaica, January 2022), and in Spanish (Dominican Republic, May 2022). The workshops included neurointerventional teams (practicing neurointerventionalists, neuroIR nurses and technicians), focused on patient selection, acutetreatment and post‐MT care of patients with stroke due to large vessel occlusion. MT skills, procedure duration and potential harmful techniques were recorded before and after by independent evaluators utilizing flow models under fluoroscopy. Overall course evaluation was performed. Press conferences were included to raise stroke awareness and emphasize the importance of early stroke presentation. Results Twenty‐two physicians and their teams from eight countries across the Caribbean completed the didactic and hands‐on training. Eighteen groups completed both pre‐ and post‐MT hands‐on testing and were included in the final analysis. Pre‐ and post‐course hands‐on assessment showed that the course effectively reduced the total time to complete a simulated MT procedure from 36.5 to 21.1 min (Figure 1; p< 1.0×10‐7). All groups showed an improvement in measures of good MT techniques, which resulted in a 39% improvement in complete reperfusion (8/18 groups achieved a TICI 3 score on pre‐course vs. 15/18 groups on post‐course). There was a significant reduction in total potentially dangerous maneuvers by 82% (p< 0.002), with 12/18 groups performing an average 2 dangerous maneuvers on pre‐course simulation vs. only 4/18 groups performing an average 1 dangerous maneuver after completing the course. Participants also demonstrated increased knowledge of stroke treatment and stroke system of care. Utilizing a basic stroke knowledge questionnaire, we found 28% respondents did not have a baseline passing grade vs 100% passed after the workshop. The average post‐workshop knowledge score was 80%. Universally the workshop was rated as very satisfactory and likely to change practice in 93% of the Dominican Republic participants and 75% among Jamaican participants. Conclusions A team‐based approach to MT training is novel, effective in reducing time to reperfusion and harmful techniques, and improves competencies. Team members independently demonstrated advanced stroke learning post‐training. To our knowledge, this is the first workshop of its kind; it is feasible, practice‐changing and creates a pathway for increasing access to MT in LTMICs

Mechanical Thrombectomy Global Access for Stroke (Mt-Glass): A Mission Thrombectomy (Mt-2020 Plus) Study

BACKGROUND: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. METHODS: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. RESULTS: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70-11.74). MTA was \u3c1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower-middle versus high: odds ratio, 0.08 [95% CI, 0.04-0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07-5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84-4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70-9.42]) were significantly associated with increased odds of MTA. CONCLUSIONS: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country\u27s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability