Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost.

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dc.contributor.author Campbell, Bruce CV en
dc.contributor.author Mitchell, Peter J en
dc.contributor.author Churilov, Leonid en
dc.contributor.author Keshtkaran, Mahsa en
dc.contributor.author Hong, Keun-Sik en
dc.contributor.author Kleinig, Timothy J en
dc.contributor.author Dewey, Helen M en
dc.contributor.author Yassi, Nawaf en
dc.contributor.author Yan, Bernard en
dc.contributor.author Dowling, Richard J en
dc.contributor.author Parsons, Mark W en
dc.contributor.author Wu, Teddy Y en
dc.contributor.author Brooks, Mark en
dc.contributor.author Simpson, Marion A en
dc.contributor.author Miteff, Ferdinand en
dc.contributor.author Levi, Christopher R en
dc.contributor.author Krause, Martin en
dc.contributor.author Harrington, Timothy J en
dc.contributor.author Faulder, Kenneth C en
dc.contributor.author Steinfort, Brendan S en
dc.contributor.author Ang, Timothy en
dc.contributor.author Scroop, Rebecca en
dc.contributor.author Barber, Peter en
dc.contributor.author McGuinness, Ben en
dc.contributor.author Wijeratne, Tissa en
dc.contributor.author Phan, Thanh G en
dc.contributor.author Chong, Winston en
dc.contributor.author Chandra, Ronil V en
dc.contributor.author Bladin, Christopher F en
dc.contributor.author Rice, Henry en
dc.contributor.author de Villiers, Laetitia en
dc.contributor.author Ma, Henry en
dc.contributor.author Desmond, Patricia M en
dc.contributor.author Meretoja, Atte en
dc.contributor.author Cadilhac, Dominique A en
dc.contributor.author Donnan, Geoffrey A en
dc.contributor.author Davis, Stephen M en
dc.contributor.author EXTEND-IA Investigators en
dc.date.accessioned 2018-12-10T00:08:37Z en
dc.date.issued 2017-01 en
dc.identifier.issn 1664-2295 en
dc.identifier.uri http://hdl.handle.net/2292/44942 en
dc.description.abstract 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.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).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.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.http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011). en
dc.format.medium Electronic-eCollection en
dc.relation.ispartofseries Frontiers in neurology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/1664-2295/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject EXTEND-IA Investigators en
dc.title Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost. en
dc.type Conference Item en
dc.identifier.doi 10.3389/fneur.2017.00657 en
pubs.begin-page 657 en
pubs.volume 8 en
dc.rights.holder Copyright: The author en
dc.identifier.pmid 29312109 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.elements-id 719863 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Medicine Department en
dc.identifier.eissn 1664-2295 en
pubs.record-created-at-source-date 2018-01-10 en
pubs.dimensions-id 29312109 en

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