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

Autor:	Campbell BCV; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Mitchell PJ; Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Churilov L; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia., Keshtkaran M; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia., Hong KS; Department of Neurology, Ilsan Paik Hospital, Inje University, Gyeonggi-do, South Korea., Kleinig TJ; Royal Adelaide Hospital, Adelaide, SA, Australia., Dewey HM; Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Clayton, VIC, Australia., Yassi N; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia., Yan B; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Dowling RJ; Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Parsons MW; Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia., Wu TY; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Brooks M; Austin Health, Heidelberg, VIC, Australia., Simpson MA; Austin Health, Heidelberg, VIC, Australia., Miteff F; Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.; Department of Radiology, Royal North Shore Hospital, St Leonards, NSW, Australia., Levi CR; Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia., Krause M; Department of Neurology, Royal North Shore Hospital, Kolling Institute, University of Sydney, St Leonards, NSW, Australia., Harrington TJ; Department of Radiology, Royal North Shore Hospital, St Leonards, NSW, Australia., Faulder KC; Department of Radiology, Royal North Shore Hospital, St Leonards, NSW, Australia., Steinfort BS; Department of Radiology, Royal North Shore Hospital, St Leonards, NSW, Australia., Ang T; Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia., Scroop R; Royal Adelaide Hospital, Adelaide, SA, Australia., Barber PA; Centre for Brain Research, University of Auckland, Auckland City Hospital, Auckland, New Zealand., McGuinness B; Auckland City Hospital, Auckland, New Zealand., Wijeratne T; Western Hospital, Footscray, VIC, Australia., Phan TG; Monash Medical Centre, Monash University, Clayton, VIC, Australia., Chong W; Monash Medical Centre, Monash University, Clayton, VIC, Australia., Chandra RV; Monash Medical Centre, Monash University, Clayton, VIC, Australia., Bladin CF; Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Clayton, VIC, Australia., Rice H; Gold Coast University Hospital, Southport, QLD, Australia., de Villiers L; Gold Coast University Hospital, Southport, QLD, Australia., Ma H; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.; Monash Medical Centre, Monash University, Clayton, VIC, Australia., Desmond PM; Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Meretoja A; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.; Department of Neurology, Helsinki University Hospital, Helsinki, Finland., Cadilhac DA; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia., Donnan GA; The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia., Davis SM; Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2017 Dec 14; Vol. 8, pp. 657. Date of Electronic Publication: 2017 Dec 14 (Print Publication: 2017).
DOI:	10.3389/fneur.2017.00657
Abstrakt:	Background: 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. Methods: 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). Results: 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. Conclusion: 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. Clinical Trial Registration: http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu