Outcomes of mechanical thrombectomy at a single-centre tertiary level public healthcare hospital in South Africa.

ABSTRACT

INTRODUCTION: Mechanical thrombectomy (MT) is standard of care for acute ischaemic stroke from large vessel occlusion following randomised controlled trials performed largely in high-income countries. Limited data exists on its effectiveness in the setting of low-and-middle-income countries. We aimed to evaluate the safety and efficacy of MT in a tertiary level public hospital in Cape Town, South Africa. METHODS: Patients with acute ischaemic stroke presenting consecutively to Groote Schuur Hospital between 1 January 2018 to 1 January 2022 with proximal intracranial occlusion in the anterior circulation treated with MT within 6 h from onset using computed tomography (CT) and CT angiography imaging-based protocols were evaluated. Demographic, clinical, radiological and procedural data were obtained from the stroke unit database. Recanalisation was evaluated post-procedure by modified Treatment in Cerebral Infarction score (mTICI). Functional independence (modified Rankin scores 0-2) and mortality at 90 days were also assessed. RESULTS: Thrombectomies were performed in 84 patients during the study period. The median age was 56 years (interquartile range, IQR) and 51% of participants were female. Median National Institute of Health Stroke Score was 18 and median baseline Alberta Stroke Programme Early CT score was 8. Bridging thrombolysis was given to 65% of participants. Median time from symptom onset to reperfusion was 339 min (IQR). Successful recanalisation (mTICI 2b/3) was obtained in 62%. At 90 days, 34% of participants gained functional independence and mortality was 34%. CONCLUSION: This study demonstrated similar rates of recanalisation and functional independence to that seen in trials in high-income countries using basic imaging despite a higher mortality and longer median time to reperfusion. This data supports the effectiveness of MT in a tertiary level public hospital in South Africa despite the challenges of providing emergent stroke care in a resource-constrained setting.