Background: 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.

Methods: 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.

Results: 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%-12.4%, in 2022).

Conclusions: 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.