The RESILIENT ¹and RESILIENT-EXTEND trials have been landmark studies, not just in Brazil, but across the global stroke community. These pivotal trials demonstrated the effectiveness of mechanical thrombectomy for acute ischemic stroke (AIS) due to large vessel occlusion – even in extended time windows. Beyond their scientific contributions, these studies did something arguably even more profound: they proved that world-class, high-quality multi-center interventional trials for neurological emergencies can be conducted in low and middle-income countries (LMICs), despite financial and logistical constraints. In this article, we explore the victories and challenges behind these groundbreaking studies and offer a roadmap for conducting high-impact research in resource in resource-limited settings. 

One of the most formidable obstacles in launching RESILIENT was securing funding and coordinating multiple stroke centers across Brazil.² Unlike many high-income country trials, which rely on extensive public and private grants, RESILIENT relied heavily on local fundings sources, advocacy efforts and creative partnerships, such as the donation of the catheters from industry supporters. Critical support came from the Brazilian Ministry of Health, which was essential to ensuring financial viability of the trial. Demonstrating the cost-effectiveness of thrombectomy was key to garnering national institutional support and integrate the trial into national health priorities.^3,4

Another major challenge was harmonizing a national network of stroke centers with widely variable resources, expertise, and infrastructure. To ensure consistency in patient care and data collection, we implemented standardized training programs for physicians, radiologists, and interventional neurologists. The use of telemedicine and centralized imaging evaluation played a crucial role in maintaining consistency in patient selection and clinical decision making. Additionally, we worked closely with emergency medical services (EMS) to optimize pre-hospital patient triage and ensure timely treatment, even within the constraints of the extended treatment window.⁴

The RESILIENT trials have set a powerful precedent for clinical research in Latin America.  They demonstrate that with local leadership, strategic funding partnerships, and capacity-building, it is entirely possible to conduct high-quality interventional trials in LMICs. The trials also emphasized the importance of national health authorities’ engagement and institutional advocacy, which ensured the translational of evidence into real-world public health policies impact.

The success of RESILIENT and RESILIENT-EXTEND is a resounding statement: Latin America can be a leader in stroke research, bringing life-saving treatments to underserved populations. Our next goal is to expand this collaborative model to other countries and regions, fostering collaboration between Latin American stroke centers to drive innovation and improve patient outcomes. We hope that the RESILIENT experience will inspire a new wave of locally driven research , ensuring that cutting-edge, live-saving therapies reach all patients- regardless of geography or economic status.