Developing a neurointervention service in a resource-limited health system: A real-world single-center experience from Iraq

Objective Neurointerventional capacity remains unevenly distributed across Iraq, and its development within existing catheterization infrastructure is poorly documented. We describe the establishment and early results of a neurointerventional service embedded within a cardiac catheterization center in Najaf, Iraq. Methods We retrospectively reviewed consecutive neurointerventional procedures at a single center from January 2023 through June 2026. Angiographic results, periprocedural complications, and discharge functional status were abstracted from the primary clinical records using pathology-specific scales. Analysis was descriptive; 2026 data are partial. Results 163 procedures were performed in 144 patients (mean age 45.2 years; 11.8% pediatric). Annual volume rose from 30 (2023) to 44 (2024) and 52 (2025), with 37 by June 2026. Aneurysm treatment was most frequent (n=64; 39.3%), followed by arteriovenous malformation (n=27) and diagnostic angiography (n=26). Among 44 coil-based aneurysm treatments, adequate occlusion (Raymond–Roy 1 or 2) was achieved in 39 (88.6%); among 20 flow-diversion treatments, immediate O'Kelly–Marotta grade C or D in 6 (30.0%), consistent with its delayed occlusion. Complete obliteration was achieved in 3 of 23 arteriovenous malformations, and mTICI 2b–3 reperfusion in 7 of 9 thrombectomies. Complications occurred in 5 procedures (3.1%) and procedure-related death in 2 (1.2%). Discharge modified Rankin Scale 0–2 occurred in 40 of 62 aneurysm patients (64.5%). Conclusions A neurointerventional service was established and expanded within a cardiac catheterization center over 3.5 years, with angiographic and safety results within the range reported by established programs. With an account of device procurement, staff cross-training, and referral pathways, these data support neurointerventional capacity-building in a resource-limited setting.