Closing the gap: Translating EVT success from global trials to MENA Practice

Title : Closing the gap: Translating EVT success from global trials to MENA Practice

Abstract:

Background: Endovascular thrombectomy (EVT) is the established standard of care for acute ischemic stroke caused by large vessel occlusion. However, real-world implementation in the Middle East and North Africa (MENA) region is challenged by disparities in healthcare resources, prehospital emergency services, and stroke system organization, leading to variable clinical outcomes.
Objective: To review real-world safety, efficacy, and functional outcomes of EVT across the Middle East, emphasizing regional system-level challenges and comparison with international benchmarks.
Methods: A narrative review was performed of published retrospective cohort studies and regional registries from Egypt, Saudi Arabia, and the broader MENA region. Studies reporting procedural success, functional outcomes, extended treatment windows, distal medium vessel occlusions, and rescue endovascular strategies were included.
Results: Successful recanalization (TICI ≥2b) in regional studies ranged from 69% to 85%, consistent with global registry data (~80%). Functional independence at 90 days (mRS 0–2) ranged from 28% to 54%, slightly lower and more variable than international trial averages of 44–71%. Symptomatic intracranial hemorrhage rates in the region were also more variable than typical global estimates (~5–7%). Prolonged prehospital delays, extended door-to-groin times, and limited availability of comprehensive stroke centers were consistently associated with higher stroke severity and poorer outcomes, particularly in patients treated beyond 6 hours.
Conclusion: While procedural success is comparable to global standards, EVT outcomes in the MENA region are strongly influenced by systemic barriers, including limited resources, delayed
emergency response, and fragmented stroke care networks. Optimizing prehospital triage, expanding access to advanced imaging, and strengthening regional stroke systems are critical to improving functional outcomes.

Biography:

Merna Walid Ahmed Amin is a first-year medical intern at Kafrelsheikh University Hospitals in Egypt, with a strong passion for neurology and cerebrovascular research. Throughout her medical education, she has actively pursued research training, completing courses on clinical research methodology, biostatistics, and evidence-based medicine. She has participated in multiple research projects, including systematic reviews and clinical audits, with a focus on stroke, neuroimaging, and acute neurological interventions.
Merna has presented research findings at local conferences and actively engages in collaborative projects with faculty mentors to improve patient care through evidence-based strategies. She is committed to advancing neurological care in resource-limited settings and hopes to contribute to policy development, stroke awareness initiatives, and the integration of innovative diagnostic and therapeutic technologies in her region.