National endovascular thrombectomy activity was associated with lower ischaemic stroke mortality-to-incidence ratio between countries but did not track within-country change, making it a candidate marker for cross-country comparison rather than an established indicator for monitoring change.
Higher national thrombectomy activity was associated with a lower ischaemic stroke mortality-to-incidence ratio between countries.
No within-country association was detected between changes in thrombectomy activity and changes in the ischaemic stroke mortality-to-incidence ratio.
The between-country association attenuated and lost statistical significance after adjustment for health expenditure and Universal Health Coverage.
Leave-one-country-out sensitivity analyses showed variability in the statistical significance of the between-country estimate.
The study design was a repeated cross-sectional ecological analysis and cannot estimate the causal effect of increasing thrombectomy provision.
National thrombectomy activity was concluded to be a candidate marker for cross-country comparison of acute stroke-service capacity, not an established indicator for monitoring change.
This research examined whether countries that perform more endovascular thrombectomy procedures (a treatment where doctors physically remove blood clots from stroke patients' brains) tend to have better stroke outcomes across Europe. Using data from 39 European and neighboring countries collected in 2016, 2019, and 2020, the researchers compared national thrombectomy rates against a measure of how many people died from ischemic stroke relative to how many had one. They found that countries with higher thrombectomy activity tended to have lower stroke death rates relative to how many strokes occurred — but this relationship weakened when accounting for overall health spending and healthcare coverage, suggesting that broader healthcare system quality may explain part of the pattern. Importantly, when the researchers looked within individual countries over time — asking whether countries that increased their thrombectomy rates saw corresponding improvements in stroke outcomes — they found no such relationship. This means that thrombectomy activity reflects stable differences between countries' healthcare systems rather than acting as a sensitive measure of improvement over time within any single country. The findings also proved sensitive to which countries were included in the analysis, further limiting confidence in the association. This research suggests that while national thrombectomy rates may be a useful rough indicator for comparing stroke care capacity across countries, it should not be used as a standalone measure to monitor whether a country's stroke care is improving over time. The authors recommend it be used alongside more direct measures of care quality. The ecological nature of the study — using country-level averages rather than individual patient data — means the findings cannot prove that increasing thrombectomy availability directly causes better stroke survival.
Gunzer F, Dudic F, Kuzu T, Frank B, van Landeghem N, Forsting M, et al.. (2026). Endovascular thrombectomy activity as a candidate marker of organised acute stroke-service capacity: a global burden of disease-based European panel study.. European stroke journal. https://doi.org/10.1093/esj/aakag121