Characterization of Barriers to Mechanical Thrombectomy Access in Georgia.

BACKGROUND: Similar to many low- and middle-income countries, the barriers limiting wider mechanical thrombectomy (MT) access in Georgia are largely unknown. Recently, the MT access score (MTAS) was introduced as a new tool for identifying and characterizing barriers to MT access. This study aimed to implement the MTAS in Georgia, a middle-income country in Eastern Europe, to assess and characterize national barriers to MT. METHODS: We applied the MTAS, which comprises 12 weighted attributes, each scored on a 0-3 scale, resulting in a total score range of 0-36, 0 being the worst possible score. Eight members of the Mission Thrombectomy regional committee from different regions of Georgia were invited as panelists in this survey. The results of the survey are shown as a median with an interquartile range. RESULTS: The median MTAS for Georgia was 17. The lowest median scores were documented for 2 attributes: lack of prehospital large vessel occlusion-specific screening [0.0 (0.0-0.0)] and telestroke networks [0.0 (0.0-0.0)], with 87.5% of panelists assessing the score as 0 for both attributes. The highest scores were obtained for emergency medical services use [3.0 (2.0-3.0)], availability of MT operators [2.0 (2.0-2.5)] followed by MT device availability and government/insurance coverage [2.0 (2.0-2.0) for each]. CONCLUSION: MTAS is a valid tool for quantitatively assessing barriers to MT in Georgia. It identified a lack of information and the presence of physical barriers as major challenges. These findings underscore the need for targeted interventions through national stroke public health initiatives to improve access to MT.