Abstract 478: MTDYNAMIC (Mechanical Thrombectomy Device Availability And Cost Variability: a Multi‐Country survey) an international effort to assess the availability of thrombectomy devices across diverse stroke care settings.

Background Despite advances in mechanical thrombectomy (MT) for acute ischemic stroke, global access remains profoundly inequitable. Fewer than 3% of eligible patients worldwide receive MT, with over a 400‐fold disparity between highest‐ and lowest‐access countries1.Low‐ and middle‐income countries (LMICs), which account for more than 85% of global stroke‐related disability‐adjusted life years (DALYs), even for thrombolysis, face unique barriers, including treatment unaffordability, fragmented procurement, and opaque pricing models 2. In high‐income settings, regional disparities persist due to variability in infrastructure readiness and pricing transparency3. Recent efforts to quantify these barriers provide structured frameworks for assessing systemic inequities in MT implementation4. Objective To systematically evaluate global variability in thrombectomy device availability and pricing, with a specific focus on identifying financial and structural barriers that limit access in high‐burden, under‐resourced regions. Methods We deployed a structured 9‐item electronic survey to approximately neurointerventionalists across 78 countries, spanning diverse health system models and income settings (World Bank classification). Responses were anonymized and stratified by geographic region and income level. Both quantitative and qualitative analyses will assess cost variability, device accessibility, and thematic patterns related to policy and procurement inefficiencies. Results Data analysis is ongoing. Preliminary response rates indicate broad geographic participation and highlight urgent interest in addressing thrombectomy affordability and infrastructure inequities. Conclusions Despite compelling evidence supporting MT's clinical efficacy and long‐term cost‐effectiveness, it remains largely inaccessible for most eligible stroke patients globally. The MT‐DYNAMIC study is the first global initiative to empirically map thrombectomy device costs and access barriers using real‐world data. Findings will inform actionable strategies for governments, global health bodies, and manufacturers to promote value‐based procurement, transparent pricing, and regional collaboration—critical steps toward reducing MT access inequities and improving stroke outcomes worldwide. 1. Asif, K., Otite, F.O., Desai, S.M., Herial, N., Inoa, V., Al‐Mufti, F., Jadhav, A.P., Dmytriw, A.A., Castonguay, A.C., Khandelwal, P., Potter‐Vig, J., Szeder, V., Kulman, T., Urrutia, V.C., Masoud, H., Toth, G., Limaye, K., Aroor, S., Brinjikji, W., ⋯ Yavagal, D.R.(2023).Mechanical Thrombectomy Global Access For Stroke (MT‐GLASS): A Mission Thrombectomy (MT‐2020 Plus) Study.Circulation, 147, 1208‐1220.https://doi.org/10.1161/CIRCULATIONAHA.122.063366 2. de Souza, A.C., Sebastian, I., Wan Zaidi, W.A., Nasreldein, A., Bazadona, D., Amaya, P., Elkady, A., Gebrewold, M.A., Vorasayan, P., Yeghiazaryan, N.S., Michel, P., Khatri, P., Pandian, J.D., Ouriques Martins, S.C., Hacke, W., 53(3): 864‐866. doi: 10.1161/STROKEAHA.121.037921. Epub 2022 Jan 24. PMID: 35067098; PMCID: PMC10031550. Aroor, S., Zevallos, C., Asif, K., Singh, N., Potter‐Vig, J., Rodríguez‐Calienes, A., Menon, B.K., Ganesh, A., Saver, J.L., Kamel, H., Alexandrov, A.W., Jauch, E.C., Miao, Z., Huo, X., Ramakrishnan, P., Desai, S.M., Limaye, K., El‐Ghanem, M., Tóth, G., ⋯ Ortega‐Gutiérrez, S. (2024). Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy. Stroke . https://doi.org/10.1161/strokeaha.124.047805