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

[11] Adopting a Patient-Centered Approach to Primary Outcome Analysis of Acute Stroke Trials Using a Utility-Weighted Modified Rankin Scale [J].

Chaisinanunkul, Napasri ;

Adeoye, Opeolu ;

Lewis, Roger J. ;

Grotta, James C. ;

Broderick, Joseph ;

Jovin, Tudor G. ;

Nogueira, Raul G. ;

Elm, Jordan J. ;

Graves, Todd ;

Berry, Scott ;

Lees, Kennedy R. ;

Barreto, Andrew D. ;

Saver, Jeffrey L. .

STROKE, 2015, 46 (08) :2238-2243

[12] Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial [J].

Davalos, Antoni ;

Cobo, Erik ;

Molina, Carlos A. ;

Chamorro, Angel ;

Angeles de Miquel, M. ;

San Roman, Luis ;

Serena, Joaquin ;

Lopez-Cancio, Elena ;

Ribo, Marc ;

Millan, Monica ;

Urra, Xabier ;

Cardona, Pere ;

Tomasello, Alejandro ;

Castano, Carlos ;

Blasco, Jordi ;

Aja, Lucia ;

Rubiera, Marta ;

Gomis, Meritxell ;

Renu, Arturo ;

Lara, Blanca ;

Marti-Fabregas, Joan ;

Jankowitz, Brian ;

Cerda, Neus ;

Jovin, Tudor G. .

LANCET NEUROLOGY, 2017, 16 (05) :369-376

[13] Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke [J].

Ganesalingam, Jeban ;

Pizzo, Elena ;

Morris, Stephen ;

Sunderland, Tom ;

Ames, Diane ;

Lobotesis, Kyriakos .

STROKE, 2015, 46 (09) :2591-2598

[14] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[15] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[16] Years of Disability-Adjusted Life Gained as a Result of Thrombolytic Therapy for Acute Ischemic Stroke [J].

Hong, Keun-Sik ;

Saver, Jeffrey L. .

STROKE, 2010, 41 (03) :471-477

[17] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[18] Cost-Effectiveness of Intra-Arterial Treatment as an Adjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke [J].

Leppert, Michelle H. ;

Campbell, Jonathan D. ;

Simpson, Jennifer R. ;

Burke, James F. .

STROKE, 2015, 46 (07) :1870-1876

[19]

Moon L., 2003, Stroke Care in OECD Countries: A comparison of treatment, costs and outcomes in 17 Countries

[20] Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 [J].

Murray, Christopher J. L. ;

Vos, Theo ;

Lozano, Rafael ;

Naghavi, Mohsen ;

Flaxman, Abraham D. ;

Michaud, Catherine ;

Ezzati, Majid ;

Shibuya, Kenji ;

Salomon, Joshua A. ;

Abdalla, Safa ;

Aboyans, Victor ;

Abraham, Jerry ;

Ackerman, Ilana ;

Aggarwal, Rakesh ;

Ahn, Stephanie Y. ;

Ali, Mohammed K. ;

Alvarado, Miriam ;

Anderson, H. Ross ;

Anderson, Laurie M. ;

Andrews, Kathryn G. ;

Atkinson, Charles ;

Baddour, Larry M. ;

Bahalim, Adil N. ;

Barker-Collo, Suzanne ;

Barrero, Lope H. ;

Bartels, David H. ;

Basanez, Maria-Gloria ;

Baxter, Amanda ;

Bell, Michelle L. ;

Benjamin, Emelia J. ;

Bennett, Derrick ;

Bernabe, Eduardo ;

Bhalla, Kavi ;

Bhandari, Bishal ;

Bikbov, Boris ;

Bin Abdulhak, Aref ;

Birbeck, Gretchen ;

Black, James A. ;

Blencowe, Hannah ;

Blore, Jed D. ;

Blyth, Fiona ;

Bolliger, Ian ;

Bonaventure, Audrey ;

Boufous, Soufi Ane ;

Bourne, Rupert ;

Boussinesq, Michel ;

Braithwaite, Tasanee ;

Brayne, Carol ;

Bridgett, Lisa ;

Brooker, Simon .

LANCET, 2012, 380 (9859) :2197-2223

← 1 2 3 →