AUTHOR=Campbell Bruce C. V. , Mitchell Peter J. , Churilov Leonid , Keshtkaran Mahsa , Hong Keun-Sik , Kleinig Timothy J. , Dewey Helen M. , Yassi Nawaf , Yan Bernard , Dowling Richard J. , Parsons Mark W. , Wu Teddy Y. , Brooks Mark , Simpson Marion A. , Miteff Ferdinand , Levi Christopher R. , Krause Martin , Harrington Timothy J. , Faulder Kenneth C. , Steinfort Brendan S. , Ang Timothy , Scroop Rebecca , Barber P. Alan , McGuinness Ben , Wijeratne Tissa , Phan Thanh G. , Chong Winston , Chandra Ronil V. , Bladin Christopher F. , Rice Henry , de Villiers Laetitia , Ma Henry , Desmond Patricia M. , Meretoja Atte , Cadilhac Dominique A. , Donnan Geoffrey A. , Davis Stephen M. , on behalf of the EXTEND-IA Investigators , Davis Stephen M , Donnan Geoffrey A , Campbell Bruce CV , Mitchell Peter J , Churilov Leonid , Yan Bernard , Dowling Richard , Yassi Nawaf , Oxley Thomas J , Wu Teddy Y , Silver Gabriel , McDonald Amy , McCoy Rachael , Kleinig Timothy J , Scroop Rebecca , Dewey Helen M , Simpson Marion , Brooks Mark , Coulton Bronwyn , Krause Martin , Harrington Timothy J , Steinfort Brendan , Faulder Kenneth , Priglinger Miriam , Day Susan , Phan Thanh , Chong Winston , Holt Michael , Chandra Ronil V , Ma Henry , Young Dennis , Wong Kitty , Wijeratne Tissa , Tu Hans , Mackay Elizabeth , Celestino Sherisse , Bladin Christopher F , Loh Poh Sien , Gilligan Amanda , Ross Zofia , Coote Skye , Frost Tanya , Parsons Mark W , Miteff Ferdinand , Levi Christopher R , Ang Timothy , Spratt Neil , Kaauwai Lara , Badve Monica , Rice Henry , de Villiers Laetitia , Barber P. Alan , McGuinness Ben , Hope Ayton , Moriarty Maurice , Bennett Patricia , Wong Andrew , Coulthard Alan , Lee Andrew , Jannes Jim , Field Deborah , Sharma Gagan , Salinas Simon , Cowley Elise , Snow Barry , Kolbe John , Stark Richard , King John , Macdonnell Richard , Attia John , D’Este Cate TITLE=Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost JOURNAL=Frontiers in Neurology VOLUME=8 YEAR=2017 URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00657 DOI=10.3389/fneur.2017.00657 ISSN=1664-2295 ABSTRACT=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).