Long Term Outcomes Of Patients With Anterior Circulation Large Vessel Occlusive Strokes Treated With Endovascular Mechanical Thrombectomy In Kenya

Abstract

Introduction: Acute ischemic stroke (AIS) in Africa is associated with poor outcomes, largely due to poor stroke care, especially in sub-Saharan Africa where management is largely supportive, owing to lack of acute stroke interventions, including thrombolysis and endovascular mechanical thrombectomy (EMT). The latter was introduced in Kenya in 2017; and we sought to assess its impact on stroke outcomes in our setting, with the hope of advancing its access in the region. Objective: Assess functional outcomes of stroke patients treated with EMT in Nairobi, Kenya. Methods: We retrospectively reviewed 13 files of patients who had EMT for AIS secondary to large vessel occlusion (LVO) in the anterior circulation at the Aga Khan University hospital in Nairobi. Our primary outcome was 12-month post-discharge functional outcome measured using the modified Rankin Scale (mRS). Descriptive statistics and Fisher's exact test were used to describe the data and assess associations, respectively. Results: 85% of all thrombectomy patients survived to discharge and 62% were functionally independent at 12 months. Neurological deterioration post thrombectomy was significantly associated with poor outcomes and occurred in 31% of the patients secondary to malignant cerebral oedema (23%) and unexplained deterioration (7.7%). An asymptomatic haemorrhagic transformation occurred in 7.7% of patients. Conclusions: Outcomes after EMT for patients with anterior circulation LVO in Kenya are propitious, with two-thirds of the patients remaining independent in the long term. Given the otherwise repugnant outcomes for LVO stroke patients, this therapy should be embraced, and systems strengthened for its optimization.