ABSTRACT NUMBER: ESOC2026A2219 IMPROVING POPULATION ACCESS TO ENDOVASCULAR STROKE CARE THROUGH REGIONAL NETWORK IMPLEMENTATION: REAL-WORLD DATA FROM SWEDEN

Abstract Background and aims Endovascular thrombectomy (EVT) is highly effective for acute ischemic stroke, yet population access remains uneven. Prior work suggests that regional organization, communication, and integration of primary stroke centers (PSCs) are critical for implementation effectiveness. We evaluated whether a structured regional stroke bundle of care was associated with improved population-level access to EVT. Methods Using the Swedish EVAS registry, we analyzed ischemic stroke and EVT activity in the Örebro and Värmland regions during 2022–2024. Following establishment of Örebro as a comprehensive stroke center in 2021, a regional stroke system was implemented including digital parallel communication, early notification pathways, continuous KPI sharing, and regular feedback and engagement with referring PSCs. Implementation effectiveness was assessed using ESO-recommended key performance indicators, primarily the proportion of ischemic stroke patients treated with EVT (EVT/AIS), and compared with national data. Results Örebro reached an EVT rate of 23% of all ischemic strokes, the highest in Sweden, while Värmland reached 15%, ranking second nationally. Increased access was observed already during the first full year after CSC establishment and remained sustained thereafter. These regions demonstrated substantially higher EVT accessibility than other Swedish regions without comparable system integration. Importantly, increased EVT access was not associated with higher serious adverse event rates or reduced early neurological improvement. Conclusions A regionally integrated stroke bundle of care emphasizing communication, feedback, and PSC inclusion was associated with rapid and sustained improvements in population access to EVT. These findings highlight that equitable stroke care depends on organizational design and stakeholder alignment rather than center maturity alone. Conflict of interest Alex Szolics: Nothing to Disclose