Geo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers

Kaiz Asif; Arun Mitra; Santiago Ortega-Gutierrez; Nabeel A Herial; Shashvat Monal Desai; Ashutosh Jadhav; Fawaz Al-Mufti; Adrija Roy; Romil Singh; Grant Brown; Amrou Sarraj; Arun Jose; Anand Alurkar; Anil Karapurkar; Arvind Sharma; Vipul Gupta; Gaurav Goel; Dheeraj Khurana; Biplab Das; Deep Das; Rahul Kumar; Jayanta Roy; Gigy Kuruttukulam; V G Pradeep Kumar; Padma Mv Srivastava; Jeyaraj Durai Pandian; Vikram Huded; Dileep Yavagal; Biju Soman; P N Sylaja

doi:10.1177/17474930241312598

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Geo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers

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Geo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers

Kaiz Asif, Arun Mitra, Santiago Ortega-Gutierrez, Nabeel A Herial, Shashvat Monal Desai, Ashutosh Jadhav, Fawaz Al-Mufti, Adrija Roy, Romil Singh, Grant Brown, …

International journal of stroke, Vol.20(6), pp.708-720

07/2025

DOI: 10.1177/17474930241312598

PMID: 39719435

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Abstract

Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited. We evaluated the spatial distribution and geographic accessibility of stroke centers in India. Data on intravenous thrombolysis capable (IVT-C) and endovascular treatment capable (EVT-C) stroke centers were collected in March 2021 from thrombectomy devices and pharmaceutical industry providers, respectively. Data were collated and geocoded to compare and calculate zonal statistics and state/union territory (UT) summaries using descriptive statistics. Data on population centers were obtained from the Survey of India website. For estimating driving times, we used the Google Distance Matrix API to find the driving distance between each population center and its nearest stroke facility. Subsequently, population coverages were estimated as a proportion of the population having access to stroke centers for each time interval and based on the population projection for the year 2020 and compared across states. A total of 566 IVT-C stroke centers were spread across 26 states and UTs of which 361 (63%) were EVT-C. Ten UTs lacked stroke centers. The average stroke centers per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Median distances to the nearest IVT-C and EVT-C centers were 115 km (IQR 66-175) and 131 km (IQR 79-198), respectively. Access within one hour to an IVT-C and an EVT-C center was available to 26.3% and 20.6% of the Indian population, respectively. Access to stroke care in India is poor, with critical regional disparities as reflected by the low number of SCPM population, long driving times, and a small population with access within the golden hour. There is an urgent need to establish IVT and EVT-capable stroke centers in the existing poorly served regions of India to increase access and improve outcomes for stroke patients.

Stroke

Stroke facilities

Treatment

Vascular events

Stroke prevalence

Developing countries

Acute stroke therapy

Thrombolysis

Details

Title: Subtitle: Geo-Spatial Analysis of Acute Ischemic Stroke Reperfusion Treatment in India: An Assessment of Distribution and Access to Centers
Creators: Kaiz Asif - Ascension
Arun Mitra - All India Institute of Medical Sciences
Santiago Ortega-Gutierrez - University of Iowa
Nabeel A Herial - Jefferson Hospital
Shashvat Monal Desai - HonorHealth
Ashutosh Jadhav - Barrow Neurological Institute
Fawaz Al-Mufti - Westchester Medical Center
Adrija Roy - Apollo Institute of Medical Sciences & Research
Romil Singh - Allegheny General Hospital
Grant Brown - University of Iowa, Biostatistics
Amrou Sarraj - University Hospitals of Cleveland
Arun Jose - Sree Chitra Thirunal Institute for Medical Sciences and Technology
Anand Alurkar - King Edward Memorial Hospital Research Centre
Anil Karapurkar - Sir H.N. Reliance Foundation Hospital and Research Centre
Arvind Sharma - Arvind Sharma, DM, Department of Neurology, Stroke Specialist and Neurosonologist Zydus Hospitals, Ahmedabad, India
Vipul Gupta - Artemis Hospitals
Gaurav Goel - Medanta The Medicity
Dheeraj Khurana - Post Graduate Institute of Medical Education and Research
Biplab Das - Narayana Health
Deep Das - Narayana Nethralaya
Rahul Kumar - Rahul Kumar, Director and Consultant Interventional Neurologist, G S Neuroscience Clinic and Research Center, Patna, India
Jayanta Roy - Institute of Neurosciences Kolkata
Gigy Kuruttukulam - Rajagiri Hospital
V G Pradeep Kumar - Baby Memorial Hospital
Padma Mv Srivastava - All India Institute of Medical Sciences Raipur
Jeyaraj Durai Pandian - Christian Medical College
Vikram Huded - Instituto de Neurociencias
Dileep Yavagal - University of Miami
Biju Soman - Sree Chitra Thirunal Institute for Medical Sciences and Technology
P N Sylaja - Sree Chitra Thirunal Institute for Medical Sciences and Technology
Resource Type: Journal article
Publication Details: International journal of stroke, Vol.20(6), pp.708-720
DOI: 10.1177/17474930241312598
PMID: 39719435
NLM abbreviation: Int J Stroke
ISSN: 1747-4949
eISSN: 1747-4949
Publisher: SAGE PUBLICATIONS LTD; LONDON
Grant note: Mission Thrombectomy (Society of Vascular and Interventional Neurology)
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Mission Thrombectomy (Society of Vascular and Interventional Neurology).
Language: English
Electronic publication date: 12/24/2024
Date published: 07/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Biostatistics; Neurosurgery
Record Identifier: 9984759116402771

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