Acesso a tratamento endovascular para acidente vascular cerebral isquémico em portugal

Translated title of the contribution: Nationwide access to endovascular treatment for acute ischemic stroke in portugal

Mariana Carvalho Dias, Ricardo Soares Dos Reis, João Vasco Santos, Ana Paiva Nunes, Patrícia Ferreira, Bruno Maia, Isabel Fragata, João Reis, Joana Ramos Lopes, Luís Cruz, Gustavo Santo, Egídio MacHado, Denis Gabriel, Rui Felgueiras, Hugo Mota Dória, Ângelo Carneiro, Manuel Correia, Luís Miguel Veloso, Pedro Barros, Tiago GregórioAndreia Carvalho, Manuel Ribeiro, Pedro Teotónio, Lia Neto, Teresa Pinho E. Melo1, Patrícia Canhão, João Pedro Filipe, Goreti Moreira, Elsa Azevedo, Maria Luís Silva, Elisa Campos Costa, Guilherme Oliveira, Liliana Pereira, Lígia Neves, Miguel Rodrigues, João Pedro Marto, Sofia Calado, Fátima Grenho, Gabriel Branco, Tiago Baptista, Jaime Rocha, Carla Ferreira, João Pinho, José Manuel Amorim, José Manuel Araújo, Rui Manuel Neiva, João Viana, Mariana Lobo, Alberto Freitas, Vítor Tedim Cruz, João Sargento-Freitas, José Castro Lopes

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
26 Downloads (Pure)


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. Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. 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

Translated title of the contributionNationwide access to endovascular treatment for acute ischemic stroke in portugal
Original languagePortuguese
JournalActa Médica Portuguesa
Issue number13
Publication statusPublished - 2021


  • Endovascular procedures
  • Ischemic stroke
  • Mechanical thrombolysis
  • Portugal
  • Thrombectomy


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