Thrombectomy for Stroke in the Public Health Care System of Brazil

Martins, Sheila Cristina Ouriques; Mont’alverne, F.; Rebello, Letícia C; Abud, Daniel Giansante; Silva, Gisele Sampaio; Lima, Fabrício Oliveira; Parente, Bruno de Sousa Mendes; Nakiri, Guilherme S.; Faria, Mário B.; Frudit, Michel Eli; Carvalho, João José Freitas de; Waihrich, Eduardo; Fiorot, José Antonio; Cardoso, Fabrício Buchdid; Hidalgo, Raquel C.T.; Zétola, Viviane Flumignan; Carvalho, Fernanda; Souza, Ana Cláudia de; Dias, F.T.; Bandeira, Diego; Alves, Maramélia Miranda; Wagner, Mário Bernardes; Carbonera, Leonardo Augusto; Oliveira‐Filho, Jamary; Bezerra, Daniel C.; Liebeskind, David S; Broderick, Joseph P.; Molina, Carlos A.; Passos, José E. Fogolin; Saver, Jeffrey L.; Pontes-Neto, Octávio M.; Nogueira, Raul G

doi:10.1056/nejmoa2000120

Cited by 166 publications

(185 citation statements)

References 23 publications

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“…The recent published results from the RESILIENT study confirmed that MT in the Public Healthcare in Brazil is feasible, safe and effective. 20 Our study shows also that these results are reproduceable in another Latin America public care system.…”

Section: Discussionsupporting

confidence: 74%

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

et al. 2020

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Background Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. Objective To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. Methods Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. Results A total of 100 patients were treated over the study period. Their mean age was 62.8 ± 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p < 0.00001) and 50% of the follow-up patients were functionally independent at 90 days. Symptomatic Intracerebral hemorrhage occurred in 5% of the patients and 90-day all case mortality was 11%. Conclusions We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.

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Section: Discussionsupporting

confidence: 74%

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

et al. 2020

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“…Although this series achieved similar results than previously reported ones with analogous protocols of rapid screening followed by intra venous fibrinolisis while being transferred to a main stroke center for mechanical trombectomy (“drip and ship” protocol) this report main highlight is showing that this kind of emergency protocol is feasible even in public hospital systems of economically developing countries of South America. More recently another report published, the multicenter RESILIENT study, 1 also confirmed that MT in the Public Healthcare was also feasible, safe and with efficacy in comparison with more conservative or standardized treatment in Brasil.…”

mentioning

confidence: 66%

Breaking the breach in Latin America. A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Plaghos¹

2020

Interv Neuroradiol

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“…The difference in outcomes is likely explained by improvements in patient selection (detecting LVO with noninvasive imaging prior to angiography), faster door-to-arterial access times and better devices to achieve faster and more complete reperfusion [10] . The THRACE (Mechanical Thrombectomy After Intravenous Alteplase vs. Alteplase Alone After Stroke), PISTE (Pragmatic Ischaemic Stroke Thrombectomy Evaluation) and RESILIENT (Randomisation of endovascular treatment with stent-retriever and/or thromboaspiration vs. best medical therapy with acute ischemic stroke due to large vessel occlusion) trials were also subsequently reported with consistent results in favor of thrombectomy [11][12][13] .…”

Section: Evidence For Endovascular Thrombectomy and The Time Window Fmentioning

confidence: 98%

Frontiers in endovascular thrombectomy for ischemic stroke

Linger¹,

Campbell²

2020

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Stroke is a leading cause of morbidity and mortality worldwide. There have been significant advances in the hyperacute treatment of patients with ischemic stroke with the advent and application of reperfusion therapies, including intravenous thrombolysis and endovascular thrombectomy. Endovascular thrombectomy involves the removal of thrombus from an artery using a mechanical retriever or aspiration with angiographic visualization. This review aims to outline the current evidence to support the use of endovascular thrombectomy and highlight areas of ongoing research.

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Thrombectomy for Stroke in the Public Health Care System of Brazil

Cited by 166 publications

References 23 publications

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Breaking the breach in Latin America: A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Breaking the breach in Latin America. A pilot study of mechanical thrombectomy in the public healthcare system in Chile

Frontiers in endovascular thrombectomy for ischemic stroke

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