ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
MTAS-MENA: Adapting the Stroke Access Barrier Index (SABI) to Enhance Mechanical Thrombectomy Access in the Middle East and North Africa Region
Ossama Yassin Mansour 1
Kaiz S. Asif 2
Violiza Inoa 3
Farid Aladham 4
Ibrahim Alnaami 5
Hosam Al-Jehani 6
Abdulrahman Alshamy 7
Faisal Alghamdi 8
Özlem Aykaç 9
Mohamed Hamdy 10
Hani Jameel Humaidan 11
Mehdi Farhoudi 12
Mahmoud Galal 13
Mohammad Ghorbani 14
Erdem Gurkas 15
Mohamed Alaa Habib 16
Nadia Hammami 17
Tamer Hassan 1
Farouk Hassan 16
SYED HUSSAIN 18
Yahia Imam 19
Seby John 18
Wael Khalifa 20
Amina El Khamlichi 21
Amr Mahmoud 10
Ahmed Ossama 1
Mostafa Mahmoud 19
Ehab S Mohamed 22
Nada Nasr 1
Atilla Ozcan Ozdemir 23
Umair Rashid 24
Salma Said 1
Abdulmonem Saied 25
Maher Saqqur 26
Khaled Mohamed Sobh 27
RYNA THEN 28
Gillian L. Gordon Perue 29
Mohammad Wasay 30
Hany Zaki eldeen 10
Fawaz Al-Mufti 31
Santiago Ortega-Gutierrez 32
Sheila Cristina Ouriques Martins 33
Dileep R. Yavagal 29
Ashfaq Shuaib 34
1. Alexandria University, Alexandria, Egypt
2. Ascension Medical Group Illinois, Chicago, United States
3. Semmes-Murphey Neurologic and Spine Institute, Memphis, United States
4. Amman specialized IR Center, Amman, Jordan
5. King Khalid University, Abha, Saudi Arabia
6. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
7. King Abdulaziz Medical City, Riyadh, Saudi Arabia
8. King Abdullah Medical City, Mecca, Saudi Arabia
9. Eskisehir Osmangazi Universitesi, Odunpazarı, Türkiye
10. Ain Shams University, Cairo, Egypt
11. Ibn Al Nafees Hospital, Manama, Bahrain
12. Tabriz University of Medical Sciences, Tabriz, Iran
13. Al-Azhar University, Nasr City, Egypt
14. University of Tehran, Tehran, Iran
15. Kartal Dr Lutfi Kirdar Sehir Hastanesi, Istanbul, Türkiye
16. Cairo University, Giza, Egypt
17. Institute National de Neurology, Tunis, Tunisia
18. Neurological Institute Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
19. Weill Cornell Medicine - Qatar, Doha, Qatar
20. Armed Forces Medical Complex in Maadi, Cairo, Egypt
21. Centre Hospitalo-Universitaire Ibn Sina, Rabat, Morocco
22. Tanta University, Tanta, Egypt
23. Eskisehir Teknik Universitesi, Eskişehir, Türkiye
24. Lahore General Hospital, Lahore, Pakistan
25. Military Tripoli general hospital, Tripoli, Libya
26. University of Toronto, Toronto, Canada
27. Al-Azhar University, Cairo, Egypt
28. Rowan University Cooper Medical School, Camden, United States
29. University of Miami Miller School of Medicine, Miami, United States
30. The Aga Khan University Hospital, Karachi, Pakistan
31. New York Medical College, Valhalla, United States
32. University of Iowa, Iowa City, United States
33. Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
34. University of Alberta, Alberta, Canada
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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.
Summary
Keywords
Access barriers, Health Disparities, healthcare systems, Mechanical thrombectomy, MENA region, Stroke
Received
17 October 2025
Accepted
26 January 2026
Copyright
© 2026 Mansour, Asif, Inoa, Aladham, Alnaami, Al-Jehani, Alshamy, Alghamdi, Aykaç, Hamdy, Jameel Humaidan, Farhoudi, Galal, Ghorbani, Gurkas, Habib, Hammami, Hassan, Hassan, HUSSAIN, Imam, John, Khalifa, El Khamlichi, Mahmoud, Ossama, Mahmoud, Mohamed, Nasr, Ozdemir, Rashid, Said, Saied, Saqqur, Sobh, THEN, Gordon Perue, Wasay, Zaki eldeen, Al-Mufti, Ortega-Gutierrez, Martins, Yavagal and Shuaib. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ossama Yassin Mansour
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