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Original research
An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke
  1. Aquilla S Turk III1,
  2. John M Campbell2,
  3. Alejandro Spiotta3,
  4. Jan Vargas3,
  5. Raymond D Turner3,
  6. M Imran Chaudry1,
  7. Holly Battenhouse4,
  8. Christine A Holmstedt2,
  9. Edward Jauch5
  1. 1Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Department of Biostatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5Department of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr AS Turk III, Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, 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 past 5 years, with few available data. The aim of this study was to analyze the cost and benefit of mechanical thrombectomy devices utilized during endovascular therapy of ischemic stroke patients.

Methods A retrospective chart review of patients that underwent intra-arterial stroke interventions was conducted. Clinical, angiographic, all devices used, procedural and postprocedural event and outcome data were collected. Thrombectomy devices were categorized as Penumbra aspiration system thrombectomy (group P) or stent retriever (group S). Statistical analysis of outcomes and costs for each group was performed.

Results 171 patients underwent mechanical thrombectomy. The Penumbra aspiration system was able to primarily achieve recanalization in 41.7% and the stent retriever in 70.4% of the time (p=0.006). The average cost was $11 159 and $16 022 (p=0.0002) in groups P and S, respectively. Average time to recanalization for group P was 85.1 min and for group S, 51.6 min (p<0.0001). Procedural complications were more frequent with the stent retriever (11.1% vs 9.0%; p=0.72) as were periprocedural significant complications (14.8 v 3%; p=0.04). Successful recanalization rates (Thrombolysis in Cerebral Infarction score 2b-3) were the same in groups P and S (78.5 vs. 77.8%). Similar rates of good neurologic outcomes were seen in group P (36.4%) and group S (50.0%) (p=0.19).

Conclusions For the treatment of acute stroke patients, the use of aspiration appears to be the most cost effective method to achieve acceptable recanalization rates and low complication rates. Stent retriever with local aspiration, despite higher costs and complication rates, yielded better overall outcome.

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