MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region

Ossama Yassin Mansour; Kaiz S. Asif; Violiza Inoa; Farid Aladham; Ibrahim Alnaami; Hosam Maher Al-Jehani; Abdulrahman Alshamy; Faisal Alghamdi; Ozlem Aykac; Mohamed Hamdy; Hany Hamadani; Mehdi Farhodi; Mahmoud Galal; Mohamed Ghorbani; Erdem Gurkas; Mohamed Alaa Habib; Nadia Hammami; Tamer Hassan; Farouk Hassan; Syed I. Hussain; Yahia Imam; Seby John; Wael Khalifa; Amina El Khamlichi; Amr Mahmoud; Ahmed Ossama; Mostafa Mahmoud; Ehab S. Mohamed; Nada Nasr; Atilla Ozcan Ozdemir; Umair Rashid; Salma Said; Abdulmonem Saied; Maher Saqqur; Khalid Sobh; Ryna Then; Gillian L Gordon Perue; Mohammed Wasay; Hany Zaki Eldeen; Fawaz Al-Mufti; Santiago Ortega-Gutierrez; Sheila Martins; Dileep R. Yavagal; Ashfaq Shuaib

doi:10.3389/fneur.2026.1727476

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MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region

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MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region

Ossama Yassin Mansour, Kaiz S. Asif, Violiza Inoa, Farid Aladham, Ibrahim Alnaami, Hosam Maher Al-Jehani, Abdulrahman Alshamy, Faisal Alghamdi, Ozlem Aykac, Mohamed Hamdy, …

Frontiers in neurology, Vol.17, 1727476

02/01/2026

DOI: 10.3389/fneur.2026.1727476

PMID: 41798813

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Abstract

Background and purposeWe developed and preliminarily validated the Stroke Access Barrier Index (SABI), adapted from the global MTAS framework, then applied it to assess potential barriers to mechanical thrombectomy access in the MENA region.MethodsCross-sectional survey with embedded instrument development and validation study. We surveyed 352 stroke and neurointerventional facility directors across the Middle East and North Africa (MENA) region, defined as 22 countries/territories, with responses obtained from 17 countries (March–June 2024), receiving 102 responses (29%). The SABI tool evaluates 12 attributes scored 0-3, yielding a total score from 0-36. Emergency medical services (EMS) utilization and health literacy were key measures.ResultsThe median SABI score for the MENA region was 18.5 (IQR: 10.0–24.0; 95% CI: 16.8–20.2), significantly lower (p < 0.001) than the global median of 22.0 (IQR: 14.0-28.0; 95% CI: 21.3–22.7). High-income countries scored 24.0, while low-income countries scored 10.0. Physical barriers (median: 4.5/9.0) and sociocultural barriers (median: 4.0/9.0) were most prominent. EMS utilization (median: 1.0) and health literacy (median: 1.0) were consistently low across all income levels. Urban facilities (median: 20.5) substantially outperformed rural facilities (median: 13.0, p < 0.001).ConclusionsThe SABI provides an exploratory framework for identifying potential MT access barriers in the MENA region. While preliminary findings suggest substantial challenges (median score 18.5), these results require validation through prospective studies linking scores to actual MT utilization and patient outcomes. This initial assessment may guide hypothesis generation for future intervention studies.

Stroke

access barriers

health disparities

healthcare systems

mechanical thrombectomy

MENA region

Details

Title: Subtitle: MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region
Creators: Ossama Yassin Mansour - Alexandria University
Kaiz S. Asif
Violiza Inoa - Semmes Murphey Foundation
Farid Aladham - Children's Specialized Hospital
Ibrahim Alnaami - King Khalid University
Hosam Maher Al-Jehani - Imam Abdulrahman Al Faisal Hospital
Abdulrahman Alshamy - King Abdulaziz Medical City
Faisal Alghamdi - King Abdullah Medical City
Ozlem Aykac - Eskişehir Osmangazi University
Mohamed Hamdy - Ain Shams University
Hany Hamadani - 1Department of Neurology, Ibn Al Nafees Hospital, Manama, Bahrain
Mehdi Farhodi - Tabriz University of Medical Sciences
Mahmoud Galal - Al-Azhar University
Mohamed Ghorbani - Tehran University of Medical Sciences
Erdem Gurkas - Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi
Mohamed Alaa Habib - Fordham University
Nadia Hammami - Society of Interventional Radiology
Tamer Hassan - Baikal Nature Reserve
Farouk Hassan - Cairo University
Syed I. Hussain - The Neurological Institute
Yahia Imam - Cornell University
Seby John - The Neurological Institute
Wael Khalifa - Armed Forces Medical College
Amina El Khamlichi - Centre Hospitalier Ibn Sina
Amr Mahmoud - Ain Shams University
Ahmed Ossama - Baikal Nature Reserve
Mostafa Mahmoud - Cornell University
Ehab S. Mohamed - Tanta University
Nada Nasr - Baikal Nature Reserve
Atilla Ozcan Ozdemir - Eskişehir Osmangazi University
Umair Rashid - Lahore General Hospital
Salma Said - Baikal Nature Reserve
Abdulmonem Saied - Tripoli Central Hospital
Maher Saqqur - University of Toronto
Khalid Sobh - Al-Azhar University
Ryna Then - Cooper Medical School of Rowan University
Gillian L Gordon Perue - University of Miami
Mohammed Wasay - Aga Khan University
Hany Zaki Eldeen - Ain Shams University
Fawaz Al-Mufti - New York Medical College
Santiago Ortega-Gutierrez - University of Iowa
Sheila Martins - Hospital de Clínicas de Porto Alegre
Dileep R. Yavagal - University of Miami
Ashfaq Shuaib - University of Alberta
Resource Type: Journal article
Publication Details: Frontiers in neurology, Vol.17, 1727476
DOI: 10.3389/fneur.2026.1727476
PMID: 41798813
NLM abbreviation: Front Neurol
ISSN: 1664-2295
eISSN: 1664-2295
Publisher: Frontiers Media S.A
Grant note: King Khalid University
The author(s) declared that financial support was received for this work and/or its publication. The authors extend their appreciation to the Deanship of Research and Graduate Studies at King Khalid University for funding this work through Large Research Project under grant number RGP2/594/46.
Language: English
Date published: 02/01/2026
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9985139274102771

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