Abstract WP101: Barriers and Facilitators to Endovascular Thrombectomy (EVT) Access: A Qualitative Study of Stroke Coordinators’ Perspectives

Background: Endovascular thrombectomy (EVT) has revolutionized treatment for large vessel occlusion (LVO) stroke, yet there are well described gaps in access. While prior studies have highlighted systemic delays in interfacility transfers, we sought to explore operational and structural barriers and facilitators to EVT access perceived by frontline stroke system stakeholders. Methods: Respondents to a 2023 nationwide U.S. electronic survey of stroke hospitals with publicly available contact information were invited to participate in virtual focus groups. Following the COREQ (COnsolidated criteria for REporting Qualitative research) guidelines, we conducted seven semi-structured virtual focus groups between March and June 2025 with stroke coordinators and medical directors representing diverse geographic regions and hospital types. Sessions were recorded and transcribed verbatim. Preliminary analysis of transcripts from the first two focus groups was conducted collaboratively by two coders using inductive thematic analysis to identify and refine emerging themes. Discrepancies between coders were resolved through team discussions. Results: A total of nine stroke coordinators from primary and comprehensive stroke centers around the country participated in the first two focus groups (Table 1). Participants were predominantly from academic medical centers and part of a multi-hospital health system, but there was diversity of representation by region, certifying body, annual stroke discharges, and size of community served. Findings clustered into four major facilitators categories: a) EMS and transfer-related; b) institutional/health system-related; c) regional/state systems of care, and d) image sharing. Emerging themes for ensuring regional access to EVT included adequate resources, communication and relationship building, coordinated transfer processes, provider and public education, image sharing, regulatory oversight, standardized workflows/protocols, and state/regional policy (Table 2). Conclusions: Stakeholders identified multi-level facilitators to EVT access that extend beyond individual hospital practices, underscoring the need for coordinated policy, infrastructure, and certification reforms. These findings suggest that improving stroke systems of care requires not only technical solutions but also organizational alignment and advocacy across institutions and regions.