Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Wiącek, Marcin; Kaczorowski, Rafał; Sieczkowski, Bartosz; Kanas, Natalia; Bartosik-Psujek, Halina

doi:10.1016/j.pjnns.2017.12.010

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…The number of AIS patients treated by means of IVT or MT has increased significantly in recent years [7][8][9]. As shown in other studies [10][11][12][13][14][15][16], we found that MT used to treat AIS in anticoagulated patients did not change long-term outcomes compared to non-coagulated AIS patients treated by MT.…”

Section: Discussionsupporting

confidence: 73%

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Nowak

Włodarczyk²,

Porębska

et al. 2020

Neurol Neurochir Pol.

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Aim of study. Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90.Clinical rationale for the study. Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited.Materials and methods. This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death).Results. Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55). Conclusion and clinical implications.In anticoagulated patients with AIS, MT does not affect long-term outcomes.

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Section: Discussionsupporting

confidence: 73%

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Nowak

Włodarczyk²,

Porębska

et al. 2020

Neurol Neurochir Pol.

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“…Kim et al found that mechanical thrombectomy cost $10,840 more than medical therapy alone. 12 When one considers that stroke affects approximately 800,000 individuals per year and approximately 33% may be eligible for mechanical thrombectomy, 21 the annual incremental cost becomes exorbitant. Despite these costs, mechanical thrombectomy has been shown in multiple recent analyses to be cost effective, primarily because of resultant reductions and related costs in long-term disability and need for rehabilitation at long-term care facilities.…”

Section: Discussionmentioning

confidence: 99%

“Strokenomics”: bending the cost curve in stroke care

Munich

Vakharia

McPheeters

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care.METHODSThe authors retrospectively reviewed the clinical and radiographic data and device-associated charges of 45 consecutive patients in whom a virtual “stroke bundle” model was used to purchase mechanical thrombectomy devices.RESULTSUse of the stroke bundle to purchase mechanical thrombectomy devices resulted in an average savings per case of $2900.93. Compared to the traditional model of charging for devices à la carte, this represented an average savings of 25.2% per case. The total amount of savings for these initial 45 cases was $130,542.00. Thrombolysis in Cerebral Infarction scale grade 2b or 3 recanalization occurred in 38 patients (84.4%) using these devices.CONCLUSIONSPurchasing devices through a bundled model resulted in substantial cost savings while maintaining the therapeutic efficacy of the procedure, further pushing the already beneficial long-term cost-benefit curve in favor of thrombectomy.

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“…The latter has been shown to have higher recanalisation rates and provide better functional outcomes than IVT alone in the setting of radiologically confirmed large vessel occlusion (LVO) [7,8]. It is thus considered as the mainstay of therapy in this selected group of patients [9]. IVT is recommended as the bridging therapy for MT treatment [10].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

Tomaszewska-Lampart

Wiącek²,

Bartosik-Psujek³

2022

Neurol Neurochir Pol.

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Introduction. Acute ischaemic stroke (AIS) is caused by significant disturbances in the cerebral bloodflow (CBF) that lead to brain ischaemia and eventually result in irreversible brain tissue damage. The main goal of its treatment is to restore bloodflow to the areas at risk of necrosis. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the mainstay of current therapy, with the latter being widely employed in selected patients with radiologically proven large vessel occlusion (LVO). Despite convincing evidence of its efficacy, up to half of patients undergoing endovascular treatment (EVT) still do not achieve a beneficial functional outcome; this is mainly due to unfavourable brain tissue sequelae. Therefore, factors associated with known adverse brain changes, such as larger infarct size or haemorrhagic and oedematous complications, should be adequately addressed.Objective. To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short-and long-term prognosis.Material and methods. We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria.Results. We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role.Conclusions. The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance.

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Mechanical thrombectomy: Determining the proportion of eligible acute ischemic stroke patients in the cohort of single academic stroke center

Abstract: Among AIS patients, in whom onset-to-arrival time allowed to initiate the endovascular procedure within 6h of symptom duration, 21% were eligible for MT treatment according to more and 33% to less restrictive criteria. It accounts for about 6% and 9% of all AIS cases, respectively.

Cited by 7 publications

References 20 publications

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes

“Strokenomics”: bending the cost curve in stroke care

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

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