Thrombectomy Improves Long-Term Survival, Quality of Life in Ischemic Stroke Patients

The long-term benefits of endovascular thrombectomy appear to offset the costs of the procedure.

LOS ANGELES — In addition to reducing disability and costs, endovascular thrombectomy improves long-term survival and quality of life among patients with ischemic stroke caused by large vessel occlusion, data from a substudy of the EXTEND-IA trial indicate.

“Not only is endovascular thrombectomy highly effective in improving patient outcomes, the cost appears to be rapidly offset by reductions in length of stay, particularly in rehabilitation, and there are significant benefits in quality of life,” Bruce Campbell, MBBS, PhD, study investigator from the Royal Melbourne Hospital in Parkville, Australia, told Neurology Advisor.

The results were presented here at the 2016 International Stroke Conference.

For the EXTEND-IA subanalysis, Dr Campbell and fellow researchers sought to evaluate the effects of endovascular thrombectomy after alteplase compared with alteplase alone on disability, quality of life, survival, and acute care cost.

“Endovascular thrombectomy is highly effective in reducing disability after ischemic stroke due to large vessel occlusion, but it does have associated costs,” Dr Campbell said. “We were interested in [determining] whether the benefits in reduced length of stay, reduced disability, and increased quality of life offset these costs.”

In all, the study included 70 patients (mean age, 69 years) who received alteplase within 4.5 hours of onset with major vessel occlusion and had computed tomography perfusion evidence of salvageable brain. Patients had a median National Institutes of Health Stroke Scale (NIHSS) score of 15 and were randomly assigned 1:1 to either endovascular thrombectomy after alteplase (n=35) or alteplase alone (n=35).

Researchers created an expected survival model using age, gender, and 3-month modified Rankin Scale (mRS).

“Stroke research trials generally follow patients for 3 months to assess functional outcome,” Dr Campbell said. “We used patients’ functional status at 3 months to model the expected lifetime benefits in survival, disability, and quality of life based on published literature examining long-term outcomes of patients. We also examined the detailed costs of care in the first 3 months.”

At 3-month follow-up, the median disability-weighted utility score, which was based on the observed mRS, was increased in the endovascular group compared with the alteplase group (0.91 vs 0.65; adjusted P=.02). Median modeled life expectancy was also greater in the endovascular group (12.6 years vs 7.4 years; adjusted P=.046).

Compared with the alteplase alone group, patients who received thrombectomy had reduced median lifetime disability-adjusted life years lost (5.5 vs 8.9; P=.02) and increased median quality-adjusted life years gained (7.5 vs 4; P=.03).

In addition, endovascular-treated patients spent less time in the hospital (median time, 5 days vs 8 days; P=.04) and in rehabilitation (median time, 0 days vs 27 days; P=.03). They also had decreased inpatient care costs in the first 3 months (median cost, US$12,188.00 vs US$26,112.00; P=.009), leading to savings of US$2,417.00 per patient after transport and thrombectomy procedural costs of US$11,507.00.

Dr Campbell said that he and colleagues found that reductions in length of stay, particularly in rehabilitation duration, offset the cost of the thrombectomy procedure in the Australian health system. “The magnitude of the benefit suggests similar results would be found in other health systems,” he said. 

Dr Campbell added that in the future, health care system re-engineering to not only deliver thrombectomy but also deliver it as fast as possible given its time-critical nature “will maximize benefits to patients and reduce the burden of stroke on our health care system.”

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Campbell B, Mitchell P, Churilov L, et al. Abstract 3. Endovascular Thrombectomy Increases Disability-Free Survival, Quality of Life and Life Expectancy After Ischemic Stroke With Reduced Costs. Presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles.