{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T13:29:44Z","timestamp":1769088584228,"version":"3.49.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003173","name":"Crafoordska Stiftelsen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003173","id-type":"DOI","asserted-by":"crossref"}]},{"name":"SUS Stiftelser & Fonder"},{"name":"ALF grants"},{"DOI":"10.13039\/501100001858","name":"VINNOVA","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001858","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003173","name":"Crafoordska Stiftelsen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003173","id-type":"DOI","asserted-by":"publisher"}]},{"name":"SUS Stiftelser & Fonder"},{"name":"ALF grants"},{"DOI":"10.13039\/501100001858","name":"VINNOVA","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001858","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for procedural and implementational effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT\/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%\u201312.4%, in 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873251347098","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T01:02:04Z","timestamp":1750122124000},"page":"1320-1327","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1896-381X","authenticated-orcid":false,"given":"Johan","family":"Wass\u00e9lius","sequence":"first","affiliation":[{"name":"Department of Radiology, Sk\u00e5ne University Hospital, Lund, Sweden 1"},{"name":"Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0026-974X","authenticated-orcid":false,"given":"Emma","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sk\u00e5ne University Hospital, Lund, Sweden 1"},{"name":"Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5050-7696","authenticated-orcid":false,"given":"Alex","family":"Szolics","sequence":"additional","affiliation":[{"name":"Department of Neurology and Rehabilitation,School of Medicine, \u00d6rebro University, \u00d6rebro, Sweden 3"},{"name":"Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden 4"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 5"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Arnberg","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden 4"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 5"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hozan","family":"Radhi","sequence":"additional","affiliation":[{"name":"Department of Neurology and Rehabilitation,School of Medicine, \u00d6rebro University, \u00d6rebro, Sweden 3"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"von Euler","sequence":"additional","affiliation":[{"name":"Department of Neurology and Rehabilitation,School of Medicine, \u00d6rebro University, \u00d6rebro, Sweden 3"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per","family":"Wester","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden 6"},{"name":"Department of Clinical Science, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden 7"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6717-0915","authenticated-orcid":false,"given":"Teresa","family":"Ullberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sk\u00e5ne University Hospital, Lund, Sweden 8"},{"name":"Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Cronberg","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sk\u00e5ne University Hospital, Lund, Sweden 8"},{"name":"Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1715-8862","authenticated-orcid":false,"given":"Nicklas","family":"Ennab Vogel","sequence":"additional","affiliation":[{"name":"Department of Medical and Health Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden 10"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magnus","family":"Esbj\u00f6rnsson","sequence":"additional","affiliation":[{"name":"Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 2"},{"name":"Department of Internal Medicine, H\u00e4ssleholm Hospital, H\u00e4ssleholm, Sweden 11"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Clinical Medicine, Ume\u00e5 University, Ume\u00e5, Sweden 6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommy","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden 4"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden 5"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Norrving","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sk\u00e5ne University Hospital, Lund, Sweden 8"},{"name":"Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 9"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8661-9063","authenticated-orcid":false,"given":"Bj\u00f6rn M","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sk\u00e5ne University Hospital, Lund, Sweden 1"},{"name":"Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden 2"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"2026012115064187500_bibr1-23969873251347098","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1001\/jama.2016.13647","article-title":"Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis","volume":"316","author":"Saver","year":"2016","journal-title":"JAMA"},{"key":"2026012115064187500_bibr2-23969873251347098","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/joim.13425","article-title":"Endovascular thrombectomy for acute ischemic stroke","volume":"291","author":"Wass\u00e9lius","year":"2022","journal-title":"J Intern Med"},{"key":"2026012115064187500_bibr3-23969873251347098","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(21)01341-6","article-title":"Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis","volume":"399","author":"Jovin","year":"2022","journal-title":"Lancet"},{"key":"2026012115064187500_bibr4-23969873251347098","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0140-6736(24)01820-8","article-title":"Endovascular therapy for acute vertebrobasilar occlusion (VERITAS): a systematic review and individual patient data meta-analysis","volume":"405","author":"Nogueira","year":"2024","journal-title":"Lancet"},{"issue":"6","key":"2026012115064187500_bibr5-23969873251347098","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1136\/jnis-2023-021366","article-title":"Endovascular thrombectomy for large ischemic strokes: meta-analysis of six multicenter randomized controlled trials","volume":"17","author":"Chen","year":"2024","journal-title":"J Neurointerv Surg"},{"key":"2026012115064187500_bibr6-23969873251347098","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1159\/000539789","article-title":"Utility of thrombectomy in nonagenarians: a scoping review","volume":"87","author":"Sugar","year":"2024","journal-title":"Eur Neurol"},{"key":"2026012115064187500_bibr7-23969873251347098","article-title":"The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: a nationwide prospective observational study","volume":"23969873251332136","author":"Hall","year":"2025","journal-title":"Eur Stroke J"},{"key":"2026012115064187500_bibr8-23969873251347098","article-title":"Global Epidemiology of stroke and access to acute ischemic stroke interventions","volume":"97","author":"Saini","year":"2021","journal-title":"Neurol"},{"key":"2026012115064187500_bibr9-23969873251347098","unstructured":"European Stroke Organisation. The website of the Stroke Action Plan for Europe (SAP-E) by the European Stroke Organisation (ESO) and the Stroke Alliance for Europe (SAFE). Projects\/stroke action-plan for Europe. Access date 1 of March 2025. https:\/\/eso-stroke.org\/projects\/stroke-action-plan\/"},{"key":"2026012115064187500_bibr10-23969873251347098","volume-title":"Criteria for distinguishing effectiveness from efficacy trials in systematic reviews","author":"Gartlehner","year":"2006"},{"key":"2026012115064187500_bibr11-23969873251347098","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3174\/ajnr.A3770","article-title":"Acute stroke intervention results: the \u201cdenominator\u201d fallacy","volume":"35","author":"Goyal","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026012115064187500_bibr12-23969873251347098","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","volume":"44","author":"Zaidat","year":"2013","journal-title":"Stroke"},{"key":"2026012115064187500_bibr13-23969873251347098","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1161\/STROKEAHA.115.012577","article-title":"Eligibility and predictors for acute revascularization procedures in a stroke center","volume":"47","author":"Vanacker","year":"2016","journal-title":"Stroke"},{"key":"2026012115064187500_bibr14-23969873251347098","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1136\/neurintsurg-2016-012515","article-title":"A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA","volume":"9","author":"Rai","year":"2017","journal-title":"J Neurointerv Surg"},{"key":"2026012115064187500_bibr15-23969873251347098","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1136\/neurintsurg-2017-013371","article-title":"A population-based incidence of M2 strokes indicates potential expansion of large vessel occlusions amenable to endovascular therapy","volume":"10","author":"Rai","year":"2018","journal-title":"J Neurointerv Surg"},{"key":"2026012115064187500_bibr16-23969873251347098","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1161\/STROKEAHA.120.029949","article-title":"Incidence of acute ischemic stroke with visible arterial occlusion: a population-based study (Dijon Stroke Registry)","volume":"51","author":"Duloquin","year":"2020","journal-title":"Stroke"},{"key":"2026012115064187500_bibr17-23969873251347098","doi-asserted-by":"publisher","DOI":"10.1177\/1591019924124826","article-title":"Procedural factors associated with successful recanalization in patients with acute ischemic stroke treated with endovascular thrombectomy-a nationwide register-based observational study","author":"Wass\u00e9lius","journal-title":"Interv Neuroradiol"},{"key":"2026012115064187500_bibr18-23969873251347098","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1161\/STROKEAHA.124.047805","article-title":"Mechanical thrombectomy access score: a systematic review and modified Delphi of global barriers to endovascular therapy","volume":"56","author":"Aroor","year":"2025","journal-title":"Stroke"},{"key":"2026012115064187500_bibr19-23969873251347098","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1177\/23969873231186042","article-title":"Delivery of acute ischaemic stroke treatments in the European region in 2019 and 2020","volume":"8","author":"Aguiar","year":"2023","journal-title":"Eur Stroke J"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23969873251347098","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23969873251347098","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/4\/1320\/65869299\/23969873251347098.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/4\/1320\/65869299\/23969873251347098.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:08:12Z","timestamp":1769026092000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/10\/4\/1320\/8377185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1177\/23969873251347098","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,1]]},"published":{"date-parts":[[2025,12,1]]}}}