Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost
AuthorCampbell, BCV; Mitchell, PJ; Churilov, L; Keshtkaran, M; Hong, K-S; Kleinig, TJ; Dewey, HM; Yassi, N; Yan, B; Dowling, RJ; ...
Source TitleFRONTIERS IN NEUROLOGY
PublisherFRONTIERS MEDIA SA
University of Melbourne Author/sDavis, Stephen; Campbell, Bruce; Mitchell, Peter; Churilov, Leonid; Dewey, Helen; Yassi, Nawaf; Yan, Bernard; Dowling, Richard; Parsons, Mark; Wu, Teddy; ...
AffiliationFlorey Department of Neuroscience and Mental Health
Medicine (Austin & Northern Health)
Medicine and Radiology
Medicine, Western Health
School of Mathematics and Statistics
Document TypeJournal Article
CitationsCampbell, B. C. V., Mitchell, P. J., Churilov, L., Keshtkaran, M., Hong, K. -S., Kleinig, T. J., Dewey, H. M., Yassi, N., Yan, B., Dowling, R. J., Parsons, M. W., Wu, T. Y., Brooks, M., Simpson, M. A., Miteff, F., Levi, C. R., Krause, M., Harrington, T. J., Faulder, K. C. ,... Davis, S. M. (2017). Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost. FRONTIERS IN NEUROLOGY, 8 (DEC), https://doi.org/10.3389/fneur.2017.00657.
Access StatusOpen Access
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735082
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. Clinical Trial Registration: http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).
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- Florey Department of Neuroscience and Mental Health - Research Publications 
- Medicine (Austin & Northern Health) - Research Publications 
- Medicine and Radiology - Research Publications 
- Medicine (Western Health) - Research Publications 
- Medicine (RMH) - Research Publications 
- Radiology - Research Publications 
- School of Mathematics and Statistics - Research Publications