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Type: Journal article
Title: Endovascular thrombectomy for ischemic stroke increases disability-free survival, quality of life, and life expectancy and reduces cost
Author: Campbell, B.
Mitchell, P.
Churilov, L.
Keshtkaran, M.
Hong, K.
Kleinig, T.
Dewey, H.
Yassi, N.
Yan, B.
Dowling, R.
Parsons, M.
Wu, T.
Brooks, M.
Simpson, M.
Miteff, F.
Levi, C.
Krause, M.
Harrington, T.
Faulder, K.
Steinfort, B.
et al.
Citation: Frontiers in Neurology, 2017; 8(DEC):6570-1-657-17
Publisher: Frontiers Media
Issue Date: 2017
ISSN: 1664-2295
Statement of
Bruce C. V. Campbell, Peter J. Mitchell, Leonid Churilov, Mahsa Keshtkaran, Keun-Sik Hong, Timothy J. Kleinig … et al. on behalf of the EXTEND-IA Investigators
Abstract: Background: Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection. Methods: Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$ reference year 2014). Results: There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12–19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00–0.91) in the alteplase-only versus 0.91 (0.65–1.00) in the endovascular group (p = 0.005). Modeled life expectancy was greater in the endovascular versus alteplase-only group (median 15.6 versus 11.2 years, p = 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR) 5.5 (3.2–8.7) versus 8.9 (4.7–13.8), p = 0.02] and more QALY gained [median (IQR) 9.3 (4.2–13.1) versus 4.9 (0.3–8.5), p = 0.03]. Endovascular patients spent less time in hospital [median (IQR) 5 (3–11) days versus 8 (5–14) days, p = 0.04] and rehabilitation [median (IQR) 0 (0–28) versus 27 (0–65) days, p = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p = 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365. Conclusion: Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life.
Keywords: Ischemic stroke; thrombolysis; endovascular therapy; mechanical thrombectomy; intraarterial therapy; solitaire stent retriever device; CT perfusion; randomized trial
Rights: © 2017 Campbell, Mitchell, Churilov, Keshtkaran, Hong, Kleinig, Dewey, Yassi, Yan, Dowling, Parsons, Wu, Brooks, Simpson, Miteff, Levi, Krause, Harrington, Faulder, Steinfort, Ang, Scroop, Barber, McGuinness, Wijeratne, Phan, Chong, Chandra, Bladin, Rice, de Villiers, Ma, Desmond, Meretoja, Cadilhac, Donnan, and Davis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
RMID: 0030082751
DOI: 10.3389/fneur.2017.00657
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