PT  - JOURNAL ARTICLE
AU  - Nguyen, S
AU  - Sheriff, F
AU  - Matuja, S
AU  - Budohoski, K
TI  - E-255 Developing a stroke thrombectomy program in urban Tanzania
AID  - 10.1136/jnis-2024-SNIS.360
DP  - 2024 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - A241--A241
VI  - 16
IP  - Suppl 1
4099  - http://jnis.bmj.com/content/16/Suppl_1/A241.1.short
4100  - http://jnis.bmj.com/content/16/Suppl_1/A241.1.full
SO  - J NeuroIntervent Surg2024 Jul 01; 16
AB  - Background Stroke is a leading cause of morbidity and mortality globally with high social and economic burden. It has been shown that the majority of mortality and lost economic productivity impacts low- and middle-income countries (LMICs).(Barbosa; Saini) This has specifically been demonstrated in Dar es Salaam, Tanzania, as shown in a prospective cohort from 2016–17 where 149 patients with imaging-confirmed stroke demonstrated a 50% mortality at 90-days. (Regenhardt) Endovascular thrombectomy (EVT) is a cost-effective way to decrease morbidity and mortality associated with stroke in high-income countries. (Barbosa) However, this treatment not currently available in the majority of LMICs, likely contributing to the significantly higher mortality rate when compared with high-income areas. Given the high incidence of stroke and lack of available interventions we seek to establish a sustainable program of neuroendovascular intervention focusing on EVT in Dar es Salaam.Methods The program was developed using 3 partially overlapping objectives: 1. Epidemiological study seeking to determine the epidemiology of acute ischemic stroke patients who would be eligible for EVT treatment; 2. Development of a consensus statement, based on the modified Delphi methodology, on the essential requirements for performing EVT; 3. Implementation of a sustainable teaching and training program for neuroendovascular intervention focusing on EVT in Dar es Salaam.Results Acute ischemic stroke registry at Bugando Medical Center in Mwanza recruited 566 patients. 57.1% of patients were admitted with NIHSS ≥6 and 19.3% were admitted within 24 hours of symptom onset. 50.4% of patients were insured, however, CT angiography was not performed in the majority of patients. The registry has been expanded to include patients admitted to Muhimbili Natioanl Hospital in Dar es Salaam with mandated CT angiography in all patients who would qualify for EVT treatment. An international panel of 35 experts in stroke thrombectomy provided insights into essential resources required to safely perform EVT in low-income settings. The first training session of neuroendovascular interevention was performed in November 2023 focusing on vascular anatomy, indications and cerebral angiography, with simulation sessions involving flow models of cerebral aneurysms and stroke.Future Directions Epidemiological data together with cost-effectiveness data will be used to determine the eligible population of patients eligible for EVT for stroke. This data together with the Delphi consensus on essential requirements for safe EVT will be used to guide resource allocation within the public sector health care in urban Tanzania. Ultimately, we aim to develop a self-sustaining program of neuro-endovascular intervention which will be based on locally available data and resources.Disclosures S. Nguyen: None. F. Sheriff: None. S. Matuja: None. K. Budohoski: None.