Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes

Abstract

The ADAPT technique represents the most technically successful yet cost-effective approach to revascularization of large vessel intracranial occlusions.

Predictors of the Aspiration Component Success of a Direct Aspiration First Pass Technique (ADAPT) for the Endovascular Treatment of Stroke Reperfusion Strategy in Anterior Circulation Acute Stroke

“…ADAPT has gained growing acceptance because it is considered to perform fast reperfusion, and probably at a lower cost. 25 Nonetheless, controversies about the relevance of the technique have arisen as in case of aspiration component failure, it might induce a potential delay in reperfusion which could have been avoided using the SR technique and also because this technique does not use a proximal flow arrest with Balloon guide catheter known to prevent embolus in new territory. 26,27 Although no comparative studies have been conducted with ADAPT versus the validated SR technique, some evidences suggest noninferiority 9 or superiority of the ADAPT technique to achieve better reperfusion rates.…”

Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note

“…Successful revascularization rates range between 58% and 83% with stan- dard stentriever techniques 3,7,15 and 79%-83% using a direct aspiration first-pass thrombectomy technique with a large-bore aspiration catheter. 5,15 Conjunctive use of stentriever and a large-bore aspiration catheter (stent retriever and aspiration technique) has been introduced 6,9 and was reported to achieve an 84%-88% recanalization rate in recent case series. More than 80% of patients could be successfully treated by these well-reported techniques, but it suggests that at least 10%-20% of emergency large-vessel occlusion cases are difficult to treat successfully.…”

“…3,4,7,8,13 Standardization of the MT technique in patients with emergency large-vessel occlusion improved recanalization rates to Thrombolysis in Cerebral Infarction (TICI) Grades 2b and 3 from 58%-72% in early experience to 79%-88% more recently. 3,7,10,15 The most widely used MT techniques involve stentriever and/or aspiration. Some conjunctive methods, such as stentriever and a balloon guide catheter or stentriever and a large-bore aspiration catheter (stentriever-aspiration, or Solumbra, technique), have been reported to improve the recanalization rate; 6,9 however, debate exists regarding how to achieve optimal recanalization safely and effectively in refractory cases.…”

Emergency thrombectomy for acute ischaemic stroke: current evidence, international guidelines, and local clinical practice

“…This technique was supported by multiple singlecentre series that showed comparable and sometimes superior results over stent retrievers, although none of these were head-to-head comparative trials. [16][17][18] The 2016 THERAPY trial was the only randomised study to compare aspiration thrombectomy versus IV-tPA alone. 19 It was terminated prematurely with a limited sample size after publication of the positive stent retriever trials, and as such failed to demonstrate a statistically significant benefit for aspiration thrombectomy over intravenous thrombolysis alone.…”

“…The cost per quality-adjusted life year (QALY) gained for thrombectomy over standard thrombolysis treatment varies between US$7988 (Sweden), US$9386 (US), US$11 651 (UK), and US$11 990 (Canada). 18,[20][21][22] Using internationally accepted willingness-to-pay per QALY threshold of the gross domestic product per capita, all of the above health care systems found endovascular thrombectomy to be cost-effective.…”