Abstract 207: Clinical Outcomes After Endovascular Thrombectomy in Large Vessel Occlusion: A Philippine Single Center Experience
Authors: Geronimo Kimberly C. 
Published: March 2024

Introduction

Endovascular thrombectomy (EVT) has emerged in the last decade to be the gold standard of care for acute ischemic stroke. The use of EVT is known internationally, mostly in the western hemisphere. Its application and accessibility differ in the Asian countries, especially in the Philippines. The only Philippine data on EVT use was a retrospective study conducted in the same institution as this paper. It included 31 subjects and showed the emerging utility of EVT in the Philippines. However its limitations are varying functional outcomes, as their point of evaluation was at the time of discharge as well as it lacking a long‐term outcome follow up.

Methods

In this single center retrospective study, subjects included were all patients who underwent EVT during the period of September 2018 to April 2023. The following variables were collected from medical charts: demographic data (age and sex), admitting MRS, NIHSS score upon admission and discharge, underlying co‐morbidities (hypertension, diabetes, history of previous stroke), use of anti‐thrombotics/anti‐coagulants as maintenance medications, CT (ASPECTS) or MR ASPECTS, history of rTPA administration prior to EVT, technique, ictus to groin time, post‐EVT recanalization score (TICI), site of occlusion, discharge MRS, and 90‐day MRS.

Results

In 2018‐2023, there were 1,595 patients admitted for acute ischemic strokes, 57 (3%) cases underwent EVT and 20 (1%) of which underwent combined EVT and IVT. The mean age was 65 with a male to female ratio of 6:5. Hypertension was a common co‐morbidity in half of the population, also diabetes and atrial fibrillation were existing in 1/3 of cases. During their admission, majority of patients (90%, n=54) presented with moderate to severe disability (MRS 3‐5) with a mean NIHSS of 16, indicating a moderate stroke severity. The identified site of occlusion is mainly in the anterior circulation (89%, n=51) and with 6 cases of posterior circulation strokes. Stentriever technique is primarily utilized in 59% (n=34), aspiration in 10% (n=6), and combined stentriever and aspiration in 17% (n=10) with a 77% (n=44) recanalization rate. Early neurologic improvement (ENI) defined as a difference of 8 points in NIHSS or a score of 0 at day 1 post‐EVT were found in 7% (n=4), 2 of which translated to a favorable outcome using the 90‐day MRS. In‐hospital mortality occurred in 24% (n=14) of cases, 6 from brain herniation and the rest were due to complications of prolonged hospitalization such as septic shock. On long term follow‐up at 90 days post ictus, 24% (n=14) had favorable outcome of MRS 0‐2. Among those grouped in the unfavorable outcome, 53% (n=23) were MRS 3, still showing marked improvement of quality of life.

Conclusion

Long‐term clinical outcome of EVT in this retrospective study is at par with the landmark trials which exhibited a number needed to treat of 2.8‐7.4. This is the single local data on the long‐term clinical outcomes of EVT in the Philippines and it aims to spread awareness that EVT is a possible and effective treatment for large vessel strokes despite wide gap in accessibility and use in the country.