Functional and reperfusion outcomes after mechanical thrombectomy at high altitude: a 32-patient series from Quito,...

Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke due to large vessel occlusion. In Ecuador, no previous national data on MT outcomes have been reported, and, to our knowledge, there are no published series performed at high altitude.

This was a retrospective, observational, descriptive study based on consecutive patients treated within a multicenter mechanical thrombectomy program in Quito, Ecuador, located at an altitude of ≈2,800 meters above sea level. Thirty-two patients treated between October 2023 and November 2024 were included. Baseline characteristics, procedural details, and 90-day functional outcomes were analyzed.

The median age was 64 years [IQR 54-72], and the mean baseline NIHSS score was 18, decreasing to 7 at discharge. The median ASPECTS was 7. Intravenous thrombolysis was administered in 59.4% of patients, and general anesthesia was used in 84.4% of procedures. Successful reperfusion (TICI 2b-3) was achieved in 90.6% of patients, with complete reperfusion (TICI 3) in 62.5%. Neurological complications occurred in 9.4% (all asymptomatic subarachnoid hemorrhages), and 18.8% of patients required decompressive craniectomy (DC). At 90 days, 53.1% achieved functional independence (mRS 0-2).

MT at high altitude (≈2,800m) in Ecuador is feasible, safe, and achieves outcomes comparable to international standards. Our study, the first multicenter experience of its kind in Ecuador, highlights a unique physiological risk for patients at this altitude: an elevated risk of cardiac pathologies as etiological factor, and increases susceptibility to severe cerebral edema requiring DC.