Large Core Thrombectomy: Feasibility of Simplified Protocol in Resource-Limited Settings

Area of Science:

• Neurology
• Interventional Radiology
• Public Health

Background:

• Endovascular thrombectomy (EVT) benefits large-core strokes, but effectiveness in low-resource settings is unclear.
• This study assesses EVT feasibility using simplified noncontrast CT and CT angiography in Vietnam.
• It addresses the gap in evidence for EVT in lower-middle-income countries.

Purpose of the Study:

• Evaluate the feasibility and outcomes of EVT for large-core strokes in a resource-constrained environment.
• Determine predictors of functional and ambulatory independence after EVT.
• Compare outcomes with existing large randomized controlled trials.

Main Methods:

• Prospective, single-center observational study at Da Nang Hospital, Vietnam (May 2023-May 2024).
• Included patients with anterior circulation large-vessel occlusion strokes, Alberta Stroke Program Early CT Score <6, NIHSS ≥6, treated within 24 hours.
• Primary outcome: modified Rankin Scale (mRS) at 90 days; secondary: functional/ambulatory independence, safety outcomes (hemorrhage, mortality).

Main Results:

• 52/157 (33.1%) patients had large-core strokes (ASPECTS <6).
• Successful reperfusion (TICI ≥2b) was 78.9%.
• At 90 days, functional independence was 23.1%, ambulatory independence 50%. Symptomatic intracranial hemorrhage: 9.6%, mortality: 25%. Successful reperfusion predicted ambulatory independence (OR 14.7).
• Indirect comparisons showed higher ambulatory independence vs. BESTT EVT arm (50.0% vs. 33.5%, P=0.033) and pooled best medical treatment (50.0% vs. 19.89%, P<0.001).

Conclusions:

• EVT is feasible for large-core stroke patients in lower-income countries with a simplified CT/CTA protocol.
• Successful reperfusion is a critical factor for improved ambulatory independence.
• This approach can improve stroke care in resource-limited settings.