Thrombectomy works in MENA stroke centres, but access gaps remain unmeasured

Mechanical thrombectomy, the catheter-based procedure that removes blood clots from large brain arteries during acute ischaemic stroke, delivers strong results in the Middle East and North Africa where it is available, according to a new systematic review and meta-analysis published in BMC Neurology. Yet the same analysis finds that the evidence covers only a fraction of the region, and that the share of eligible patients who actually receive the treatment remains unknown.

The review, led by Eyad Jamileh and colleagues, pooled aggregate data from published studies of thrombectomy-treated patients across prespecified MENA countries. The clinical evidence was predominantly observational and centre-based, meaning it reports what happened to patients who reached and underwent the procedure at particular hospitals, not how the whole population fared.

Twenty-nine reports describing 29 distinct investigations were included. Fourteen of these represented an estimated 2,118 unique thrombectomy-treated patients and contributed to at least one of the primary meta-analyses. The researchers used random-effects models with Hartung-Knapp confidence intervals, pooling single-arm proportions on the logit scale, and took specific steps to avoid double-counting patients from overlapping cohorts.

The headline result concerns functional recovery. Among nine cohorts comprising 1,576 patients with evaluable 90-day follow-up, the pooled rate of functional independence, defined as a modified Rankin Scale score of 0 to 2 at approximately 90 days, was 58.4 percent. The confidence interval ran from 43.8 to 71.6 percent, and heterogeneity was very high, with an I-squared of 91.9 percent and a 95 percent prediction interval stretching from 19.4 to 89.1 percent. In practical terms, while favourable outcomes are clearly achievable in the region, results varied enormously from one cohort to another.

Reperfusion success was more consistent. Eleven datasets covering 1,559 patients yielded a pooled successful-reperfusion rate, defined as TICI or mTICI grade 2b to 3, of 85.8 percent, with a confidence interval of 78.4 to 91.0 percent and an I-squared of 84.9 percent. This suggests that, where thrombectomy is performed in the region, surgeons and interventionalists frequently succeed in reopening the blocked vessel.

Safety figures followed a similar pattern of wide but bounded variation. Five studies comprising 632 patients produced a pooled 90-day mortality of 13.0 percent, with a confidence interval of 7.7 to 21.2 percent. Six datasets covering 712 patients yielded a pooled frequency of symptomatic intracranial haemorrhage, a feared procedural complication, of 7.1 percent, with a confidence interval of 3.0 to 15.6 percent and an I-squared of 78.4 percent.

The authors were careful about how they handled overlapping data. Two investigations from Jeddah recruited partially overlapping patient populations and were managed using outcome-specific deduplication. Other studies from the same institution with possible participant overlap were retained as distinct investigations only when they addressed separate research questions and were not double-counted within a pooled endpoint.

Beyond the clinical numbers, the review separately examined health-system evidence through a structured narrative synthesis. Separate service studies identified substantial variation across the region in thrombectomy availability, workforce capacity, 24-hour coverage, transfer pathways, telestroke networks, and reimbursement. These are the structural factors that determine whether a patient with a large-vessel occlusion can actually reach a thrombectomy-capable centre within the critical treatment window.

The conclusion the authors draw is deliberately measured. Published cohorts from selected MENA thrombectomy centres demonstrate that high reperfusion rates and favourable functional outcomes are achievable among treated patients, although clinical outcomes vary substantially between cohorts. At the same time, the proportion of all thrombectomy-eligible patients who accessed treatment remains unknown, and many MENA countries are not represented in the clinical evidence at all.

That last point is the study’s most important caveat. Regional service studies independently identify important workforce and access limitations, but the authors state that their effects on population-level treatment rates and clinical outcomes could not be quantified. In other words, the review can confirm that the procedure works in the centres that publish their results, but it cannot say how many stroke patients across the Middle East and North Africa are missing out on it, or what those access gaps cost in disability and death. Filling that gap, the analysis implies, will require better data from more countries, not just from the region’s leading stroke centres.

Subject of Research: Outcomes and access barriers for mechanical thrombectomy in acute ischaemic stroke across the Middle East and North Africa

Article Title: Mechanical thrombectomy for acute ischemic stroke in the Middle East and North Africa: a systematic review and meta-analysis of clinical outcomes, treatment delays, and access to care

Article References: Jamileh, E., Zinet, A., Muhammad, F., Farooq, O., Katrib, M., Hmidoush, A., Sze, S., Zakkar, M., & Antoun, I. (2026). Mechanical thrombectomy for acute ischemic stroke in the Middle East and North Africa: a systematic review and meta-analysis of clinical outcomes, treatment delays, and access to care. BMC Neurology. https://doi.org/10.1186/s12883-026-05568-z

Image Credits: AI Generated

DOI: 10.1186/s12883-026-05568-z

Keywords: mechanical thrombectomy, acute ischemic stroke, Middle East and North Africa, systematic review, meta-analysis, functional independence, reperfusion, symptomatic intracranial haemorrhage, stroke care access, telestroke, BMC Neurology, Mechanical