title: Sequential endovascular thrombectomy approach (SETA) to acute ischemic stroke: preliminary single-centre results and cost analysis.
abstract: BACKGROUND
  We report the preliminary results of a single-centre experience in the endovascular treatment (ET) of acute ischemic stroke (AIS) with a sequential endovascular thrombectomy approach (SETA), which comprehends a direct aspiration first-pass technique (ADAPT) eventually followed by stent retriever thrombectomy.
  
  
  METHODS
  We prospectively analyzed data from 16 patients with severe to moderate AIS and CT angiography demonstration of large intracranial vessel occlusion treated with SETA between July 2013 and March 2014. We evaluated recanalization rate, clinical outcome after 90 days as well as differential costs of aspiration and stent-assisted thrombectomy.
  
  
  RESULTS
  A group of 16 patients met the eligibility criteria to undergo ET with a baseline NIHSS score of 22 (range 12-39). In 15/16 cases, we obtained target vessel recanalization, 11 cases with ADAPT technique alone. Modified rankin score (mRS) at 90 days follow-up was ≤2 in 9/16 patients (56%). ADAPT technique had a lower device-related cost than stent-assisted thrombectomy leading to an overall saving of -2,747.28 <euro>.
  
  
  CONCLUSIONS
  Our preliminary data suggest that a SETA beginning with direct aspiration could be useful to optimize ET of stroke in terms of invasiveness, safety and cost-effectiveness allowing recanalization with low complication rate.
authors: Department of Radiology, Bolzano Central Hospital, Bolzano, Italy, alcomai@gmail.com.
authors: Alessio
authors: A
authors: Comai
authors: Thomas
authors: T
authors: Haglmüller
authors: Federica
authors: F
authors: Ferro
authors: Elisa
authors: E
authors: Dall'Ora
authors: Roberto
authors: R
authors: Currò Dossi
authors: Giampietro
authors: G
authors: Bonatti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000601:surgery*; D003365:Costs and Cost Analysis; D057510:Endovascular Procedures; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy / Q000191:economics* / Q000379:methods*
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