MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region

Abstract

Background and purpose We developed and preliminarily validated the Stroke Access Barrier Index (SABI), adapted from the global MTAS framework, then applied it to assess potential barriers to mechanical thrombectomy access in the MENA region. Methods Cross-sectional survey with embedded instrument development and validation study. We surveyed 352 stroke and neurointerventional facility directors across the Middle East and North Africa (MENA) region, defined as 22 countries/territories, with responses obtained from 17 countries (March–June 2024), receiving 102 responses (29%). The SABI tool evaluates 12 attributes scored 0-3, yielding a total score from 0-36. Emergency medical services (EMS) utilization and health literacy were key measures. Results The median SABI score for the MENA region was 18.5 (IQR: 10.0–24.0; 95% CI: 16.8–20.2), significantly lower ( p < 0.001) than the global median of 22.0 (IQR: 14.0-28.0; 95% CI: 21.3–22.7). High-income countries scored 24.0, while low-income countries scored 10.0. Physical barriers (median: 4.5/9.0) and sociocultural barriers (median: 4.0/9.0) were most prominent. EMS utilization (median: 1.0) and health literacy (median: 1.0) were consistently low across all income levels. Urban facilities (median: 20.5) substantially outperformed rural facilities (median: 13.0, p < 0.001). Conclusions The SABI provides an exploratory framework for identifying potential MT access barriers in the MENA region. While preliminary findings suggest substantial challenges (median score 18.5), these results require validation through prospective studies linking scores to actual MT utilization and patient outcomes. This initial assessment may guide hypothesis generation for future intervention studies.