Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost

被引：46

作者：

Campbell, Bruce C. V. ^{[1
]}

Mitchell, Peter J. ^{[2
]}

Churilov, Leonid ^{[3
]}

Keshtkaran, Mahsa ^{[3
]}

Hong, Keun-Sik ^{[4
]}

Kleinig, Timothy J. ^{[5
]}

Dewey, Helen M. ^{[6
,7
]}

Yassi, Nawaf ^{[1
,3
]}

Yan, Bernard ^{[1
]}

Dowling, Richard J. ^{[2
]}

Parsons, Mark W. ^{[8
]}

Wu, Teddy Y. ^{[1
]}

Brooks, Mark ^{[9
]}

Simpson, Marion A. ^{[9
]}

Miteff, Ferdinand ^{[8
,10
]}

Levi, Christopher R. ^{[8
]}

Krause, Martin ^{[11
]}

Harrington, Timothy J. ^{[10
]}

Faulder, Kenneth C. ^{[10
]}

Steinfort, Brendan S. ^{[10
]}

Ang, Timothy ^{[8
]}

Scroop, Rebecca ^{[5
]}

Barber, P. Alan ^{[12
]}

McGuinness, Ben ^{[13
]}

Wijeratne, Tissa ^{[14
]}

Phan, Thanh G. ^{[15
]}

Chong, Winston ^{[15
]}

Chandra, Ronil V. ^{[15
]}

Bladin, Christopher F. ^{[6
,7
]}

Rice, Henry ^{[16
]}

de Villiers, Laetitia ^{[16
]}

Ma, Henry ^{[3
,15
]}

Desmond, Patricia M. ^{[2
]}

Meretoja, Atte ^{[1
,17
]}

Cadilhac, Dominique A. ^{[3
,18
]}

Donnan, Geoffrey A. ^{[3
]}

Davis, Stephen M. ^{[1
]}

机构：

[1] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Dept Med & Neurol, Parkville, Vic, Australia

[2] Univ Melbourne, Royal Melbourne Hosp, Dept Radiol, Parkville, Vic, Australia

[3] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Parkville, Vic, Australia

[4] Inje Univ, Dept Neurol, Ilsan Paik Hosp, Gyeonggi Do, South Korea

[5] Royal Adelaide Hosp, Adelaide, SA, Australia

[6] Eastern Hlth, Dept Neurosci, Clayton, Vic, Australia

[7] Monash Univ, Eastern Hlth Clin Sch, Clayton, Vic, Australia

[8] Univ Newcastle, Prior Res Ctr Brain & Mental Hlth Res, John Hunter Hosp, Newcastle, NSW, Australia

[9] Austin Hlth, Heidelberg, Vic, Australia

[10] Royal North Shore Hosp, Dept Radiol, St Leonards, NSW, Australia

[11] Univ Sydney, Dept Neurol, Royal North Shore Hosp, Kolling Inst, St Leonards, NSW, Australia

[12] Univ Auckland, Ctr Brain Res, Auckland City Hosp, Auckland, New Zealand

[13] Auckland City Hosp, Auckland, New Zealand

[14] Western Hosp, Footscray, Vic, Australia

[15] Monash Univ, Monash Med Ctr, Clayton, Vic, Australia

[16] Gold Coast Univ Hosp, Southport, Qld, Australia

[17] Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland

[18] Monash Univ, Stroke & Ageing Res, Dept Med, Sch Clin Sci,Monash Hlth, Clayton, Vic, Australia

来源：

FRONTIERS IN NEUROLOGY | 2017年 / 8卷

基金：

英国医学研究理事会;

关键词：

ischemic stroke; thrombolysis; endovascular therapy; mechanical thrombectomy; intraarterial therapy; Solitaire stent retriever device; CT perfusion; randomized trial; STENT-RETRIEVER THROMBECTOMY; RANDOMIZED CONTROLLED-TRIAL; MECHANICAL THROMBECTOMY; INTRAARTERIAL TREATMENT; IMAGING SELECTION; THERAPY; TIME; THROMBOLYSIS; THRACE; DALYS;

D O I：

10.3389/fneur.2017.00657

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 alteplaseonly 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. c 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.

引用

页数：7

共 29 条

[1] Cost-Effectiveness of Thrombectomy in Patients With Acute Ischemic Stroke The THRACE Randomized Controlled Trial [J].

Achit, Hamza ;

Soudant, Marc ;

Hosseini, Kossar ;

Bannay, Aurelie ;

Epstein, Jonathan ;

Bracard, Serge ;

Guillemin, Francis .

STROKE, 2017, 48 (10) :2843-2847

[2] Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke [J].

Aronsson, Mattias ;

Persson, Josefine ;

Blomstrand, Christian ;

Wester, Per ;

Levin, Lars-Ake .

NEUROLOGY, 2016, 86 (11) :1053-1059

[3]

*AUSTR BUR STAT, 2017, LIF TABL STAT TERR A

[4] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[5] Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial [J].

Bracard, Serge ;

Ducrocq, Xavier ;

Mas, Jean Louis ;

Soudant, Marc ;

Oppenheim, Catherine ;

Moulin, Thieriy ;

Guillemin, Francis .

LANCET NEUROLOGY, 2016, 15 (11) :1138-1147

[6] The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS) [J].

Cadilhac, Dominique A. ;

Dewey, Helen M. ;

Vos, Theo ;

Carter, Rob ;

Thrift, Amanda G. .

HEALTH AND QUALITY OF LIFE OUTCOMES, 2010, 8

[7] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[8] Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke [J].

Campbell, Bruce C. V. ;

Donnan, Geoffrey A. ;

Lees, Kennedy R. ;

Hacke, Werner ;

Khatri, Pooja ;

Hill, Michael D. ;

Goyal, Mayank ;

Mitchell, Peter J. ;

Saver, Jeffrey L. ;

Diener, Hans-Christoph ;

Davis, Stephen M. .

LANCET NEUROLOGY, 2015, 14 (08) :846-854

[9] Imaging selection in ischemic stroke: feasibility of automated CT-perfusion analysis [J].

Campbell, Bruce C. V. ;

Yassi, Nawaf ;

Ma, Henry ;

Sharma, Gagan ;

Salinas, Simon ;

Churilov, Leonid ;

Meretoja, Atte ;

Parsons, Mark W. ;

Desmond, Patricia M. ;

Lansberg, Maarten G. ;

Donnan, Geoffrey A. ;

Davis, Stephen M. .

INTERNATIONAL JOURNAL OF STROKE, 2015, 10 (01) :51-54

[10] A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy (EXTEND-IA) [J].

Campbell, Bruce C. V. ;

Mitchell, Peter J. ;

Yan, Bernard ;

Parsons, Mark W. ;

Christensen, Soren ;

Churilov, Leonid ;

Dowling, Richard J. ;

Dewey, Helen ;

Brooks, Mark ;

Miteff, Ferdinand ;

Levi, Christopher ;

Krause, Martin ;

Harrington, Timothy J. ;

Faulder, Kenneth C. ;

Steinfort, Brendan S. ;

Kleinig, Timothy ;

Scroop, Rebecca ;

Chryssidis, Steve ;

Barber, Alan ;

Hope, Ayton ;

Moriarty, Maurice ;

McGuinness, Ben ;

Wong, Andrew A. ;

Coulthard, Alan ;

Wijeratne, Tissa ;

Lee, Andrew ;

Jannes, Jim ;

Leyden, James ;

Phan, Thanh G. ;

Chong, Winston ;

Holt, Michael E. ;

Chandra, Ronil V. ;

Bladin, Christopher F. ;

Badve, Monica ;

Rice, Henry ;

de Villiers, Laetitia ;

Ma, Henry ;

Desmond, Patricia M. ;

Donnan, Geoffrey A. ;

Davis, Stephen M. .

INTERNATIONAL JOURNAL OF STROKE, 2014, 9 (01) :126-132

← 1 2 3 →