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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 050-057
DOI: 10.1055/s-0042-1749150
Original Article

Establishing a New Neurointerventional Facility in a Remote Area of a Low–Middle Income Country (LMIC): Initial Experience

Nishtha Yadav
1   Department of Neuroradiology, School of Excellence in Neurosurgery Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Ambuj Kumar
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Ketan Hedaoo
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Anivesh Jain
3   Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Kamalraj Singh
3   Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
,
Aditya Vikram
2   Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
› Institutsangaben Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
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Abstract

Background Timely performed Neurointervention procedures in patients with neurovascular disorders save them from mortality and lifelong morbidity, in addition to relieving the immense economic and social burden associated with these diseases.

Materials and Methods We retrospectively reviewed data of neurointerventions performed in our hospital from November 2019 till March 2021. Patient age, sex, diagnosis, preoperative, and postoperative imaging findings were collected and analyzed. Types of procedures, success/failure, procedure-related and procedure-unrelated complications were noted and described.

Results Total 161 procedures were done (diagnostic n = 89, therapeutic n = 72). Among the 72 cases of therapeutic procedures, angiographic success was noted in 60 cases, partial success was noted in 5 cases (RR grade 3 occlusion) and failure was noted in 7 cases [mechanical thrombectomy (n = 2), coiling (n = 1), flow diverter (n = 1), Caroticocavernous fistula (n = 1), cerebral Arteriovenous malformation (n = 2)]. Among therapeutic cases (n = 72), patient outcome was categorized as improved (with mRS 0-2 at discharge) in 64 cases (60 neurointerventions, 4 converted to surgery), morbidity in form of weakness was noted in 2 cases, mortality was noted in 8 cases. There were no hemorrhagic complications due to rupture or dissection. Ischemic complications were noted in form of thromboembolic complications in three cases and vessel occlusion (delayed MCA occlusion) in one case.

Conclusion With recent efforts by medical associations and governments to provide access to these lifesaving, disability averting neuro-interventions, it’s important to recognize and define challenges in implementation of neuro-intervention services. In this article, we share our early experience in establishing a neurointervention facility in a backward region of a low–middle income country.

Keywords

neurointervention - LMIC - endovascular

Ethical Approval

The study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


Informed Consent

Informed consent was gathered from the patient and consent to publish images was obtained.




Publikationsverlauf

Artikel online veröffentlicht:
01. Juli 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Pandian JD, Srikanth V, Read SJ, Thrift AG. Poverty and stroke in India: a time to act. Stroke 2007; 38 (11) 3063-3069
    CrossrefPubMedSuche in Google Scholar
  • 2 Ambekar S, Madhugiri V, Pandey P, Yavagal DR. Cerebral aneurysm treatment in India: results of a national survey regarding practice patterns in India. Neurol India 2016; 64 (Suppl): S62-S69
    CrossrefPubMedSuche in Google Scholar
  • 3 Harsha KJ. Successful endovascular neurosurgical practice in resource-poor exclusive rural neuro-hospital setup. J Neurosci Rural Pract 2016; 7 (Suppl. 01) S13-S17
    PubMedSuche in Google Scholar
  • 4 India SDG. . Accessed December 8, 2020 at: sdgindiaindex.niti.gov.in
  • 5 Angell BJ, Prinja S, Gupt A, Jha V, Jan S. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: overcoming the challenges of stewardship and governance. PLoS Med 2019; 16 (03) e1002759
    CrossrefPubMedSuche in Google Scholar
  • 6 Fennell VS, Martirosyan NL, Palejwala SK, Lemole Jr GM, Dumont TM. Morbidity and mortality of patients with endovascularly treated intracerebral aneurysms: does physician specialty matter?. J Neurosurg 2016; 124 (01) 13-17
    CrossrefPubMedSuche in Google Scholar