title: An investigation of the cost and benefit of mechanical thrombectomy for endovascular treatment of acute ischemic stroke.
abstract: BACKGROUND
  The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the past 5 years, with few available data. The aim of this study was to analyze the cost and benefit of mechanical thrombectomy devices utilized during endovascular therapy of ischemic stroke patients.
  
  
  METHODS
  A retrospective chart review of patients that underwent intra-arterial stroke interventions was conducted. Clinical, angiographic, all devices used, procedural and postprocedural event and outcome data were collected. Thrombectomy devices were categorized as Penumbra aspiration system thrombectomy (group P) or stent retriever (group S). Statistical analysis of outcomes and costs for each group was performed.
  
  
  RESULTS
  171 patients underwent mechanical thrombectomy. The Penumbra aspiration system was able to primarily achieve recanalization in 41.7% and the stent retriever in 70.4% of the time (p=0.006). The average cost was $11 159 and $16 022 (p=0.0002) in groups P and S, respectively. Average time to recanalization for group P was 85.1 min and for group S, 51.6 min (p<0.0001). Procedural complications were more frequent with the stent retriever (11.1% vs 9.0%; p=0.72) as were periprocedural significant complications (14.8 v 3%; p=0.04). Successful recanalization rates (Thrombolysis in Cerebral Infarction score 2b-3) were the same in groups P and S (78.5 vs. 77.8%). Similar rates of good neurologic outcomes were seen in group P (36.4%) and group S (50.0%) (p=0.19).
  
  
  CONCLUSIONS
  For the treatment of acute stroke patients, the use of aspiration appears to be the most cost effective method to achieve acceptable recanalization rates and low complication rates. Stent retriever with local aspiration, despite higher costs and complication rates, yielded better overall outcome.
authors: Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Aquilla S
authors: AS
authors: Turk
authors: John M
authors: JM
authors: Campbell
authors: Alejandro
authors: A
authors: Spiotta
authors: Jan
authors: J
authors: Vargas
authors: Raymond D
authors: RD
authors: Turner
authors: M Imran
authors: MI
authors: Chaudry
authors: Holly
authors: H
authors: Battenhouse
authors: Christine A
authors: CA
authors: Holmstedt
authors: Edward
authors: E
authors: Jauch
mesh_terms: D002545:Brain Ischemia / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000191:economics*; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000601:surgery; D017131:Thrombectomy / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome
keywords: Aneurysm; Stroke