Key result
Higher national EVT activity is linked to lower between-country ischaemic stroke mortality-to-incidence ratios.
Why the study?
Acute stroke-care organisation might contribute to variation in ischaemic stroke outcomes across Europe, but the association of national endovascular thrombectomy activity with stroke burden was unclear.
Does higher national endovascular thrombectomy activity associate with a lower ischaemic stroke mortality-to-incidence ratio across European countries?
Cross-Sectional (n=39)
Yes
Does higher national endovascular thrombectomy activity associate with a lower ischaemic stroke mortality-to-incidence ratio across European countries?
Effect estimate: fully standardised β = -0.42 (95% CI -0.79 to -0.05)
p-value: p=0.027
National endovascular thrombectomy activity differentiates countries with lower ischaemic stroke mortality and may serve as a useful cross-country candidate marker for organised acute stroke-service capacity.
National thrombectomy activity marks countries with lower stroke mortality-to-incidence ratios; hypothesis-generating without within-country confirmation.
Introduction Acute stroke-care organisation might contribute to variation in ischaemic stroke outcomes across Europe. We assessed whether national endovascular thrombectomy activity was associated with Global Burden of Disease–derived ischaemic stroke burden across European and adjacent countries. Patients and methods We conducted a repeated cross-sectional ecological analysis of a balanced three-wave panel of 39 countries (2016, 2019 and 2020) using a consistent thrombectomy data source. The primary outcome was the ischaemic stroke mortality-to-incidence ratio. We used a within–between model with wave fixed effects, adjusted for Socio-Demographic Index and population aged 65 years or older. Results Between countries, higher thrombectomy activity was associated with a lower mortality-to-incidence ratio (fully standardised β = −0.42, 95% confidence interval −0.79 to −0.05; P = .027), whereas no within-country association was detected (β = +0.10, −0.07 to +0.26). The between-country estimate attenuated after joint adjustment for health expenditure and Universal Health Coverage (β = −0.28; P = .051) and after adjustment for stroke incidence (β = −0.33; P = .061). In leave-one-country-out analyses, P values ranged from .007 to .061. Discussion The between-country estimate is more vulnerable to unmeasured national differences and could not be separated from health-system resources. This ecological study cannot estimate the causal effect of increasing thrombectomy provision. Conclusion National thrombectomy activity distinguished countries with lower ischaemic stroke mortality relative to incidence but did not track within-country change. It remains a candidate marker for cross-country comparison, not an established indicator for monitoring change, and should be interpreted alongside directly measured quality-of-care indicators.
No takes yet. Share an insight, caveat, or question.
Gunzer et al. (2026) conducted a cross-sectional in Ischaemic stroke (n=39). National endovascular thrombectomy activity vs. Lower national endovascular thrombectomy activity was evaluated on Ischaemic stroke mortality-to-incidence ratio (fully standardised β = -0.42, 95% CI -0.79 to -0.05, p=0.027). Higher national endovascular thrombectomy activity was associated with a lower between-country ischaemic stroke mortality-to-incidence ratio (standardised β = -0.42), though no within-country temporal association was detected.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: