Single-Center Study Compares Endovascular Treatments for Acute Ischemic Stroke

August 28, 2015—Aquilla S. Turk, MD, et al published findings from a study that sought to compare the cost and efficacy of current endovascular stroke therapies in the Journal of NeuroInterventional Surgery (JNIS, 2015;7:666–670).

In JNIS, the investigators noted that the background of the study is that the use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the last 5 years, but few data are available comparing the cost, clinical, and angiographic outcomes associated with available techniques.

The investigators performed a single-center retrospective review of the medical record and hospital financial database of all ischemic stroke cases admitted from 2009 to 2013. They compared the three discrete treatment methods used during this time: the traditional Penumbra system (PS; Penumbra, Inc.), 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.

In the study, 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. Average times to recanalization were 88 minutes with PS, 47 minutes with SRLA, and 37 minutes with ADAPT. Similar rates of good functional outcomes were seen in the three groups (PS 36% vs SRLA 43% vs ADAPT 47%).

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