Bridging the Neurovascular Care Gap in a Small Island Nation: Five-Year Experience from the First Dedicated Neuroendovascular Center in the Maldives

Abstract

Introduction: Neuroendovascular therapy has significantly advanced the management of cerebrovascular disorders; however, access to specialized neurointerventional services remains limited in geographically isolated and resource-constrained healthcare systems. The Maldives established its first dedicated neuroendovascular center in 2019. This study describes the five-year development of the service and evaluates patient characteristics, disease spectrum, procedural patterns, and temporal growth of neurovascular care delivery.

Materials and Methods: A single-center retrospective observational cohort study was conducted at Abdul Rahman Dhon Kaleyfaanu (ADK) Hospital, Malé, Maldives, including all consecutive patients undergoing diagnostic or therapeutic neuroendovascular procedures between January 2019 and October 2023. Data were obtained through retrospective review of the institutional neurovascular database, cerebral angiography reports, procedural records, and electronic medical records. Demographic characteristics, diagnostic categories, procedure types, and annual procedural volumes were analyzed. Descriptive statistics and inferential analyses, including chi-square tests, independent-samples t-tests, one-way analysis of variance, and linear regression analysis, were performed.

Results: A total of 321 neuroendovascular procedures were included. The mean age of patients was 51.8 ± 15.7 years, with an equal distribution of males and females. Cerebral aneurysms (36.8%) and ischemic cerebrovascular disease (32.1%) were the most common indications. Diagnostic cerebral angiography accounted for 72.0% of procedures, while therapeutic interventions comprised 28.0%, including flow diversion (6.2%), mechanical thrombectomy (4.4%), and intrasaccular aneurysm treatment (3.7%). Annual procedural volume increased from 2 procedures in 2019 to 139 procedures in 2023. Linear regression demonstrated a significant upward trend in procedural volume (coefficient of determination = 0.89, P = 0.016). Significant associations were observed between diagnostic categories and patient sex (P < 0.001) and age group (P < 0.001).

Conclusion: Establishment of a dedicated neuroendovascular center in the Maldives resulted in rapid expansion of comprehensive neurovascular services and reduced dependence on overseas referral. This experience demonstrates that advanced neurointerventional programs can be successfully developed in small island healthcare systems through coordinated infrastructure development, specialist training, multidisciplinary collaboration, and sustainable healthcare financing.