Stroke, Socioeconomics, and Mechanical Thrombectomy: A Call for Equity in Indian Neurovascular Care

Abstract

Acute ischemic stroke (AIS), predominantly caused by large vessel occlusion (LVO), remains a major global contributor to disability and mortality. Mechanical thrombectomy (MT), a minimally invasive endovascular procedure, has revolutionized AIS management, particularly for patients unresponsive to intravenous thrombolysis. Landmark randomized controlled trials—such as MR CLEAN, ESCAPE, DAWN, and DEFUSE-3—have confirmed the efficacy of MT, even extending the treatment window to 24 hours post-symptom onset in select cases.

Despite these clinical breakthroughs, MT remains underutilized in India, with fewer than 0.1% of eligible stroke patients receiving the intervention annually. In Rajasthan, where approximately 148,895 strokes occur each year—30% involving LVO—only 110 MT procedures had been reported by 2021, over half performed at a single centre in PMCH, Bedla, Udaipur. Barriers such as lack of awareness, economic constraints, insufficient infrastructure, and regional healthcare disparities limit access to this life-saving therapy.

The economic impact is also alarming. Stroke affects a significant portion of the working-age population, resulting in lost productivity, reduced wages, and increased caregiver burdens, ultimately leading to national productivity losses exceeding 1.02 trillion. Since it has proven clinical and cost-effectiveness, expanding access to MT should be a key public health focus.

This paper supports a comprehensive approach that includes government backing, public education, healthcare workforce development, and financial grants to expand the use of MT. These initiatives could greatly lower stroke-related illness and death, while also protecting economic productivity and enhancing quality of life for people from different socioeconomic backgrounds.