MANAGEMENT OF HEMORRHAGIC STROKE IN A TERTIARY FACILITY IN KENYA

Abstract

Introduction: The advent of endovascular treatment for ruptured intracranial aneurysms is now well established worldwide. However, there are few reports as to the treatment outcomes nor the efficacy of coil embolization in the African context and especially in sub-Saharan Africa.  We present the initial data over 5 years detailing the initial experience of endovascular therapies in Kenya including indications, methods and outcomes from a single institution. We also compare outcome using historical controls from the same institution. Methods: We examined prospectively collected data over 3 years from 2015- 2018 in continuous hospital data base for patients with aneurysmal subarachnoid haemorrhage. Outcome data using the Glasgow Outcome Score (GOS) at 6 months was also collected. We also collected data of patients over the years 2011-2014 as historical controls. We examined for univariate and multivariate associations with mortality and functional outcome using mR scale. Results: The study comprised 70 patients treated between 2012-2018.32 patients treated between 2012-2014 via microsurgical clipping and 38 patients treated between 2015-2018 , 75% treated via endovascular therapy and 25% treated via microsurgical ablation. Mean follow up was 1yrs (Range 0.5-2yrs). Overall mortality was 11% and 22% of patients had an unfavourable outcome. There was a significant reduction in mortality 29% vs 11% as compared to historical averages. Conclusions: Endovascular therapy is feasible and efficacious. There has been a significant reduction in mortality over the last 3 years as compared to the prior years.