BARRIERS TO MECHANICAL THROMBECTOMY IN AFRICA

The emergence of mechanical thrombectomy (MT) as a standard of care has revolutionized the management of proximal large vessel occlusions (LVOs) in patients with acute ischemic stroke (AIS). Despite the significant advances and benefits associated with MT in the treatment of proximal LVOs in developed countries, African countries continue to lag in the use and adaptability MT in treating proximal LVOs. This study seeks to highlight the problems threatening endovascular therapy in Africa. For this narrative review, PubMed and Google Scholar were used to search for literature on mechanical thrombectomy and endovascular treatment of LVOs in Africa. Selection criteria were manuscripts published in the last 10 years and addressed challenges with MT. 42 papers from 21 African nations were found and reviewed. The major challenges and impediments to MT in Africa were, a lack of government policy on stroke care, a suboptimal health care financing model that makes endovascular treatment nearly impossible to afford, delay in presenting to the hospital after stroke onset coupled with few emergency services with some countries having none, lack of specialized training, as well as, scarcity of neuroradiological infrastructure. This is an advocacy call for more radical, effective, and evidence-based management of patients with proximal LVOs in Africa. Meanwhile, concerted efforts should be aimed at the prevention of stroke in Africa through the use of guidelines such as the stroke quadrangle to tame the scourge of stroke in Africa.