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Original research
Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes
  1. Aquilla S Turk1,
  2. Raymond Turner2,
  3. Alejandro Spiotta2,
  4. Jan Vargas2,
  5. Christine Holmstedt2,
  6. Shelly Ozark2,
  7. Julio Chalela2,
  8. Tanya Turan2,
  9. Robert Adams2,
  10. Edward C Jauch3,
  11. Holly Battenhouse4,
  12. Brian Whitsitt2,
  13. Matt Wain5,
  14. M Imran Chaudry1
  1. 1Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Medical University of South Carolina, Public Health Sciences, Charleston, South Carolina, USA
  5. 5Medical University of South Carolina, Hospital Administration, Charleston, South Carolina, USA
  1. Correspondence to Dr Aquilla S Turk, Department of Radiology and Radiological Sciences, Medical University of South Carolina, 96 Jonathan Lucas St. CSB 210, Charleston, SC 29425, USA; turk{at}musc.edu

Abstract

Introduction The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the last 5 years. Few data are available comparing the cost and clinical and angiographic outcomes associated with available techniques. The aim of this study is to compare the cost and efficacy of current endovascular stroke therapies.

Methods A single-center retrospective review was performed of the medical record and hospital financial database of all ischemic stroke cases admitted from 2009 to 2013. Three discrete treatment methodologies used during this time were compared: traditional Penumbra System (PS), stent retriever with local aspiration (SRLA) and A Direct Aspiration first Pass Technique (ADAPT). Statistical analyses of clinical and angiographic outcomes and costs for each group were performed.

Results 222 patients (45% men) underwent mechanical thrombectomy. Successful revascularization was defined as Thrombolysis In Cerebral Infarction (TICI) 2b/3 flow, which was achieved in 79% of cases with PS, 83% of cases with SRLA, and 95% of cases with ADAPT. The average total cost of hospitalization for patients was $51 599 with PS, $54 700 with SRLA, and $33 611 with ADAPT (p<0.0001). Average times to recanalization were 88 min with PS, 47 min with SRLA, and 37 min with ADAPT (p<0.0001). Similar rates of good functional outcomes were seen in the three groups (PS 36% vs SRLA 43% vs ADAPT 47%; p=0.4).

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

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