Large Core Thrombectomy: Feasibility Of Simplified Protocol In Resource-Limited Settings

IntroductionSeveral trials have demonstrated the benefits of endovascular thrombectomy (EVT) for large-core strokes (ASPECTS < 6). However, its effectiveness in lower-middle-income countries with resource-limited settings remains uncertain. This study evaluated the feasibility of EVT for large-core strokes using a simplified imaging protocol with non-contrast CT (NCCT) and CT angiography (CTA) in a resource-constrained environment. MethodsWe conducted a prospective, single-center, observational study from May 2023 to May 2024 at Da Nang Hospital, Vietnam. Patients with anterior circulation large-vessel occlusion strokes, ASPECTS < 6 on NCCT, admission NIHSS [&ge;] 6, and EVT within 24 hours were included. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Functional independence was defined as mRS 0-2 and ambulatory independence as mRS 0-3. Safety outcomes included symptomatic intracranial hemorrhage (sICH). Outcomes were compared based on reperfusion success (mTICI [&ge;]2b vs. 0-2a), ASPECTS (0-2 vs. 3-5), and time window ([&le;]6 vs. >6 hours). ResultsAmong 157 EVT-treated patients, 52 (33.1%) had ASPECTS < 6. The median age was 62.5 years, and 57.7% were male. Median onset-to-hospital time was 4.1 hours (IQR 1.8-7.9), admission NIHSS 15 (IQR 13-19.5), and initial ASPECTS 4 (IQR 3-4). Successful reperfusion (mTICI [&ge;]2b) was achieved in 78.9%. At 90 days, the median mRS was 3.5 (IQR 3-5.5). Functional independence was observed in 23.1% and ambulatory independence in 50%. sICH occurred in 9.6%, and mortality was 25%. Successful reperfusion was the only independent predictor of ambulatory independence (OR 14.7, 95% CI 1.6-134). Patients with ASPECTS 3-5 had significantly higher ambulatory independence than those with ASPECTS 0-2 (58.5% vs. 18.2%, p=0.017). No significant differences were found between early and late-window groups. ConclusionEVT is feasible for large-core stroke patients in lower-income countries using a simplified NCCT-CTA protocol. Successful reperfusion is a key determinant of improved outcomes.