Endovascular Treatment for Stroke in a Single Center in a Developing Country: Permanent Training is the Key

OBJECTIVE: In Mexico, the systematic implementation of mechanical thrombectomy has been delayed due to several factors, such as the conditions of the healthcare system. The objective of this report is to explain the experience in our center going through these circumstances, how we have overcome them, our results, and our pending challenges. METHODS: This is a single-center, independent, and retrospective study of prospectively collected data destined to record consecutive patients treated with endovascular techniques at a Mexican hospital that implemented a mechanical thrombectomy program for large vessel occlusion (LVO). Patient selection began in February 2017 and ended in January 2020. Patients selected were between the ages of 18 and 80, and could be treated within 8 hours after onset of symptoms. The timeline of the analysis was divided in half (i.e., 18 months). We prognosticate that our concept of permanent training could have an impact on clinical outcomes. RESULTS: In all, 73 patients gathered, of which 60.3% were women and 39.7% were men, with an average patient age of 62 years old. The average Onset-Door time was 248 minutes, and mean Door-Recanalization time was 91.7 minutes, where 29.6% (27.2 min) were used in the endovascular procedure per se. The results obtained were as follows: five (6%) patients with a thrombolysis in cerebral infarction (TICI) <2B and nine patients (12.3%) with a TICI 2B. TICI 2C and 3 were considered optimal results and found in 59 (80.8%) patients. It was found that 17 (23%) patients treated in the first 18 months had favorable outcomes (modified Ranking Scale [mRS] <3), and in the last 18 months, 45 (33%) patients had favorable outcomes (p = 0.0001). CONCLUSION: Developing countries such as Mexico usually present particular conditions that are not part of the algorithms generated in developed countries. Nevertheless, with logistic adaptation, creativity, and above all, permanent training, similar results to those in other parts of the world can be achieved.