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

Abstract

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.

Manejo avanzado del infarto cerebral en un hospital público chileno: trombectomía mecánica en el Hospital Barros Luco Trudeau

“…Este estudio corresponde a una experiencia de implementación de trombectomía mecánica en un hospital público chileno durante 7 años que se suma a otras recientes publicaciones que exponen el desarrollo de Tmec en servicios públicos de latinoamérica y que han obtenido resultados favorables 24,25 .…”

Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments

“…The implementation of mechanical thrombectomy occurred in a small number of hospitals in all countries and remains mostly restricted to private hospitals. Chile has had thrombectomy as a government policy with official reimbursement to public hospitals since January 2020 2 (29). The RESILIENT trial (30), a randomized thrombectomy trial across stroke centers in the Brazilian Public Healthcare System, demonstrated the safety, efficacy, and cost-effectiveness of this treatment in underresourced settings.…”

The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network

“…This is a retrospective analysis of a prospectively collected database comparing two cohorts of patients treated within our MT program at the Instituto de Neurocirugia Dr. Asenjo (INCA) in Chile. Our program, as shown in a previous publication [15] is based on a large stroke network with one MT capable center (INCA) and five referring hospitals, with neurologists, stroke care and intravenous thrombolysis (IVT) capacity, in a metropolitan area in Santiago, covering approximately 3.3 million inhabitants from 3 different public administrative health areas. These referral centers transfer patients with MT criteria using a drip and ship model.…”