Endovascular Treatment of Ischemic Stroke in a Developing Country

Abstract

Background: There is inequality in access to recent advancements in endovascular treatment of acute ischemic stroke (AIS), and Mexico is unusually sensitive to such inequality. Aims: To report the initial experience of the Mexican Endovascular Reperfusion Registry (MERR). Methods: The MERR is an academic, independent, prospective, multicenter, observational registry of patients treated with endovascular reperfusion techniques in Mexican hospitals. The registry includes information on demographic and clinical characteristics, diagnostic procedures, treatments, selected time metrics, and outcomes. Results: In all, 49 (57.1% female) patients from 8 centers were included and had the following characteristics: median National Institute of Health Stroke Scale score, 16; median Alberta Stroke Program Early CT Score score, 9; received intravenous tissue-type plasminogen activator, 49%; and treated with mechanical devices, 39 (79.6%), including 20 treated with stent retriever alone, 2 with retriever and intra-arterial thrombolysis (IAt), 10 with catheter aspiration (4 in combination with IAt), 6 with a combination of catheter aspiration and stent retriever, and 1 with IAt followed by balloon angioplasty. Recanalization (TICI 2b or better) was achieved in 69.4% of the patients. The median clot to recanalization time was 30 minutes. A modified Rankin scale ≤2 was achieved in 44.9% of the patients, and 68.2% of these were treated with stent retriever ( P = .011). Procedure-related morbidity was 12.2%, 7 patients presented intracerebral hemorrhage (71.4% asymptomatic), and all-cause mortality was 6.1%. Conclusions: Endovascular treatment of AIS in Mexico is feasible and has an efficacy comparable to that of other countries. Still, many challenges remain, especially pertaining to high costs and difficulties in equality in access to treatment.

Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion

“…The barriers in LMIC that lead to inequity in endovascular care are mainly due to the high cost of the procedure, lack of endovascular specialists, and late times to presentation, among others. This was shown in the Mexican Endovascular Reperfusion Registry (MERR), which supported the effectiveness of thrombectomy but noted that treatment was mainly feasible in private hospitals (30). Similarly, the RESILIENT trial conducted in Brazil was the first clinical trial that evaluated the benefits of thrombectomy in patients with LVO in LMIC presenting within 8 h from stroke symptoms (31).…”

Moringa oleifera: A Tree of Life as a Promising Medicinal Plant for Neurodegenerative Diseases

“…Cerebral ischemia/stroke is a condition that occurs as a result of the blockage of an artery that supplies oxygen and nutrients to the brain, thereby leading to the motor, sensory, and cognitive dysfunction . It is a leading cause of death and serious long-range disability worldwide. , Despite the disease being one of the main contributors to morbidity and mortality, there have been only limited achievements in clinical therapy in the last few decades . Therefore, the development of emerging medicines or compounds for the management of stroke is tempted as future studies.…”

“…86 It is a leading cause of death and serious long-range disability worldwide. 87,88 Despite the disease being one of the main contributors to morbidity and mortality, there have been only limited achievements in clinical therapy in the last few decades. 89 Therefore, the development of emerging medicines or compounds for the management of stroke is tempted as future studies.…”

Crocins for Ischemic Stroke: A Review of Current Evidence

“…Due to the limitations of the aforementioned therapies, there have been continuing efforts to discover, develop, research, and implement new therapies for IS (Marquez-Romero et al, 2020;Williams et al, 2020). A number of natural ingredients and traditional herbal medicines have been investigated as potential therapies for IS, including ginsenoside Rg1 and Rb1 (Gao, Bai et al, 2020), Naoxinqing (NXQ) (Bei et al, 2004), Buyang Huanwu Decoction (Hao et al, 2012), saffron (SF) (Sharma et al, 2020) and related formulas including Naodesheng (Sugawara and Chan, 2003;Hao et al, 2015), Weinaokang (Zhang et al, 2010), also known as Sailoutong (SLT) (Fan et al, 2021).…”