title: Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes.
abstract: BACKGROUND
  The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the last 5 years. Few data are available comparing the cost and clinical and angiographic outcomes associated with available techniques. The aim of this study is to compare the cost and efficacy of current endovascular stroke therapies.
  
  
  METHODS
  A single-center retrospective review was performed of the medical record and hospital financial database of all ischemic stroke cases admitted from 2009 to 2013. Three discrete treatment methodologies used during this time were compared: traditional Penumbra System (PS), stent retriever with local aspiration (SRLA) and A Direct Aspiration first Pass Technique (ADAPT). Statistical analyses of clinical and angiographic outcomes and costs for each group were performed.
  
  
  RESULTS
  222 patients (45% men) underwent mechanical thrombectomy. Successful revascularization was defined as Thrombolysis In Cerebral Infarction (TICI) 2b/3 flow, which was achieved in 79% of cases with PS, 83% of cases with SRLA, and 95% of cases with ADAPT. The average total cost of hospitalization for patients was $51,599 with PS, $54,700 with SRLA, and $33 ,11 with ADAPT (p<0.0001). Average times to recanalization were 88 min with PS, 47 min with SRLA, and 37 min with ADAPT (p<0.0001). Similar rates of good functional outcomes were seen in the three groups (PS 36% vs SRLA 43% vs ADAPT 47%; p=0.4).
  
  
  CONCLUSIONS
  The ADAPT technique represents the most technically successful yet cost-effective approach to revascularization of large vessel intracranial occlusions.
authors.affiliation: Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Aquilla S
authors.initials: AS
authors.lastname: Turk
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Turner
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Spiotta
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Vargas
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Holmstedt
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Shelly
authors.initials: S
authors.lastname: Ozark
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Chalela
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Turan
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Adams
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.affiliation: Medical University of South Carolina, Public Health Sciences, Charleston, South Carolina, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Battenhouse
authors.affiliation: Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Whitsitt
authors.affiliation: Medical University of South Carolina, Hospital Administration, Charleston, South Carolina, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Wain
authors.affiliation: Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: M Imran
authors.initials: MI
authors.lastname: Chaudry
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000191:economics / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D020521:Stroke / Q000191:economics / Q000601:surgery*; D017131:Thrombectomy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke