Pichardo Omar, Alan Picazo, Jorge Chudyk, Castillon Omar, Zuñiga Jonathan
Neurosurgery Department, Hospital Regional 1o de Octubre, ISSSTE, Ciudad de, Mexico.
Neurosurgery Department, Centro Médico ABC, Ciudad de, Mexico.
J Neuroendovasc Ther. 2021;15(2):86-93. doi: 10.5797/jnet.oa.2020-0088. Epub 2020 Sep 17.
In Mexico, the systematic implementation of mechanical thrombectomy has been delayed due to several factors, such as the conditions of the healthcare system. The objective of this report is to explain the experience in our center going through these circumstances, how we have overcome them, our results, and our pending challenges.
This is a single-center, independent, and retrospective study of prospectively collected data destined to record consecutive patients treated with endovascular techniques at a Mexican hospital that implemented a mechanical thrombectomy program for large vessel occlusion (LVO). Patient selection began in February 2017 and ended in January 2020. Patients selected were between the ages of 18 and 80, and could be treated within 8 hours after onset of symptoms. The timeline of the analysis was divided in half (i.e., 18 months). We prognosticate that our concept of permanent training could have an impact on clinical outcomes.
In all, 73 patients gathered, of which 60.3% were women and 39.7% were men, with an average patient age of 62 years old. The average Onset-Door time was 248 minutes, and mean Door-Recanalization time was 91.7 minutes, where 29.6% (27.2 min) were used in the endovascular procedure per se. The results obtained were as follows: five (6%) patients with a thrombolysis in cerebral infarction (TICI) <2B and nine patients (12.3%) with a TICI 2B. TICI 2C and 3 were considered optimal results and found in 59 (80.8%) patients. It was found that 17 (23%) patients treated in the first 18 months had favorable outcomes (modified Ranking Scale [mRS] <3), and in the last 18 months, 45 (33%) patients had favorable outcomes ( = 0.0001).
Developing countries such as Mexico usually present particular conditions that are not part of the algorithms generated in developed countries. Nevertheless, with logistic adaptation, creativity, and above all, permanent training, similar results to those in other parts of the world can be achieved.
在墨西哥，由于医疗系统状况等多种因素，机械取栓术的系统实施有所延迟。本报告的目的是阐述我们中心在经历这些情况时的经验、我们是如何克服这些问题的、我们的结果以及我们面临的待解决挑战。
这是一项单中心、独立的回顾性研究，对前瞻性收集的数据进行分析，旨在记录在一家实施了大血管闭塞（LVO）机械取栓项目的墨西哥医院接受血管内技术治疗的连续患者。患者选择从2017年2月开始，至2020年1月结束。入选患者年龄在18至80岁之间，且能在症状发作后8小时内接受治疗。分析时间线分为两半（即18个月）。我们预测我们的持续培训理念可能会对临床结果产生影响。
总共收集了73例患者，其中60.3%为女性，39.7%为男性，患者平均年龄为62岁。平均发病到入院时间为248分钟，平均入院到再通时间为91.7分钟，其中29.6%（27.2分钟）用于血管内手术本身。获得的结果如下：5例（6%）脑梗死溶栓（TICI）<2B，9例（12.3%）TICI 2B。TICI 2C和3被认为是最佳结果，在59例（80.8%）患者中发现。发现在前18个月接受治疗的17例（23%）患者有良好结局（改良Rankin量表[mRS]<3），在后18个月，45例（33%）患者有良好结局（P = 0.0001）。
像墨西哥这样的发展中国家通常存在一些特殊情况，这些情况并不在发达国家生成的算法范围内。然而，通过后勤调整、创造力，最重要的是持续培训，可以取得与世界其他地区类似的结果。
