title: Periprocedural cost-effectiveness analysis of mechanical thrombectomy for acute ischemic stroke in the stent retriever era.
abstract: BACKGROUND
  Early reperfusion is critical for favorable outcomes in acute ischemic stroke (AIS). Stent retrievers lead to faster and more complete reperfusion than previous technologies. Our aim is to compare the cost-effectiveness of stent retrievers to the previous mechanical thrombectomy devices.
  
  
  METHODS
  Retrospective review of endovascularly treated large-vessel AIS. Data from all consecutive patients who underwent thrombectomy from January 2012 through November 2012 were collected. Baseline characteristics, the total procedural cost, the rates of successful recanalization [modified thrombolysis in cerebral ischemia (mTICI) scores of 2b or 3], and the length of stay at the hospital were compared between the stent retriever (SR) and the non-stent retriever (NSR) groups.
  
  
  RESULTS
  After excluding the patients who underwent concomitant extracranial stenting (n = 22) or received intra-arterial tissue plasminogen activator only (n = 6), the entire cohort included 150 patients. The cost of the reperfusion procedure was significantly higher in the SR compared to the NSR group (USD 13,419 vs. 9,308, p <0.001). We were unable to demonstrate a statistically significant difference in the rates of mTICI 2b/3 reperfusion (81 vs. 74%, p = 0.337) or the length of stay (11.1 ± 9.1 vs. 12.8 ± 9.6 days, p = 0.260) amongst the SR and the NSR patients.
  
  
  CONCLUSIONS
  The procedural costs of thrombectomy for AIS are increasing and account for the bulk of hospitalization reimbursement. The impact of these expenditures in the long-term sustainability of stroke centers deserves greater consideration. While it is likely that the SR technology results in higher rates of optimal reperfusion, better clinical outcomes, and shorter lengths of stay, larger studies are needed to prove its cost-effectiveness.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Tareq
authors.initials: T
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Chung-Huan
authors.initials: CH
authors.lastname: Sun
authors.affiliation: Humanitarian Tracker, Vienna, Va., USA.
authors.forename: Taha
authors.initials: T
authors.lastname: Kass-Hout
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Belagaje
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Anderson
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA ; Neurosurgery, WellStar Medical Group, Marietta, Ga., USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Neurology, Emory University School of Medicine, Atlanta, Ga., USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
keywords: Acute ischemic stroke; Cost-effectiveness; Stent retriever; Tissue plasminogen activator