Emerging Utility of Endovascular Thrombectomy in the Philippines: A Single-center Clinical Experience

Abstract

Background and Objective. Stroke has remained one of the primary causes of significant morbidity and mortality. Among the therapeutic options for acute stroke management, endovascular thrombectomy is intended to remove the thrombi within the intracerebral vasculature and restore adequate perfusion to the surrounding penumbra. It is recommended up to 24 hours from onset of neurologic symptom. In the Philippines, only a few tertiary healthcare institutions are able to offer and perform endovascular thrombectomies. The aim was to describe the profile and discharge outcomes of endovascular thrombectomy for acute ischemic stroke at a tertiary hospital in our country.

Methods. We conducted a retrospective records review among 924 patients admitted for acute ischemic stroke from October 2018 to August 2021 who underwent mechanical thrombectomy. Clinical and functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Score (mRS).

Results. Among 31 patients included in the study, 29 subjects (93.5%) had moderate to severe disability (mRS 3–5),  and 25 (80.6%) had moderate stroke (NIHSS 6–21) on admission. The identified site of the cerebrovascular thrombi was within the M1 segment of the middle cerebral artery (41.9%, n=13). The stent retriever approach was performed in 19 participants (61.2%). Upon discharge, only 7 (22.6%) had favorable functional outcomes (MRS 0–2), and 9 (29.0%) resulted in mortality. Successful reperfusion was achieved in 92.3% of the patients.

Conclusion. Overall, endovascular thrombectomy is a possible treatment option for large vessel acute ischemic stroke in developing countries.