학술논문
Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost
Document Type
article
Author
Bruce C. V. Campbell; Peter J. Mitchell; Leonid Churilov; Mahsa Keshtkaran; Keun-Sik Hong; Timothy J. Kleinig; Helen M. Dewey; Nawaf Yassi; Bernard Yan; Richard J. Dowling; Mark W. Parsons; Teddy Y. Wu; Mark Brooks; Marion A. Simpson; Ferdinand Miteff; Christopher R. Levi; Martin Krause; Timothy J. Harrington; Kenneth C. Faulder; Brendan S. Steinfort; Timothy Ang; Rebecca Scroop; P. Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G. Phan; Winston Chong; Ronil V. Chandra; Christopher F. Bladin; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M. Desmond; Atte Meretoja; Dominique A. Cadilhac; Geoffrey A. Donnan; Stephen M. Davis; on behalf of the EXTEND-IA Investigators; Stephen M Davis; Geoffrey A Donnan; Bruce CV Campbell; Peter J Mitchell; Richard Dowling; Thomas J Oxley; Teddy Y Wu; Gabriel Silver; Amy McDonald; Rachael McCoy; Timothy J Kleinig; Helen M Dewey; Marion Simpson; Bronwyn Coulton; Timothy J Harrington; Brendan Steinfort; Kenneth Faulder; Miriam Priglinger; Susan Day; Thanh Phan; Michael Holt; Ronil V Chandra; Dennis Young; Kitty Wong; Hans Tu; Elizabeth Mackay; Sherisse Celestino; Christopher F Bladin; Poh Sien Loh; Amanda Gilligan; Zofia Ross; Skye Coote; Tanya Frost; Mark W Parsons; Christopher R Levi; Neil Spratt; Lara Kaauwai; Monica Badve; Ayton Hope; Maurice Moriarty; Patricia Bennett; Andrew Wong; Alan Coulthard; Andrew Lee; Jim Jannes; Deborah Field; Gagan Sharma; Simon Salinas; Elise Cowley; Barry Snow; John Kolbe; Richard Stark; John King; Richard Macdonnell; John Attia; Cate D’Este
Source
Frontiers in Neurology, Vol 8 (2017)
Subject
Language
English
ISSN
1664-2295
Abstract
BackgroundEndovascular 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.MethodsLarge 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).ResultsThere 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.ConclusionThrombectomy 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.Clinical Trial Registrationhttp://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).