التفاصيل البيبلوغرافية
| العنوان: |
Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost |
| المؤلفون: |
Campbell, Bruce C. V., Mitchell, Peter J., Churilov, Leonid, Keshtkaran, Mahsa, Hong, Keun-Sik, Kleinig, Timothy J., Dewey, Helen M., Yassi, Nawaf, Yan, Bernard, Dowling, Richard J., Parsons, Mark W., Wu, Teddy Y., Brooks, Mark, Simpson, Marion A., Miteff, Ferdinand, Levi, Christopher R., Krause, Martin, Harrington, Timothy J., Faulder, Kenneth C., Steinfort, Brendan S., Ang, Timothy, Scroop, Rebecca, Barber, P. Alan, McGuinness, Ben, Wijeratne, Tissa, Phan, Thanh G., Chong, Winston, Chandra, Ronil V., Bladin, Christopher F., Rice, Henry, de Villiers, Laetitia, Ma, Henry, Desmond, Patricia M., Meretoja, Atte, Cadilhac, Dominique A., Donnan, Geoffrey A., Davis, Stephen M., EXTEND-IA Investigators |
| المساهمون: |
Department of Neurosciences, Neurologian yksikkö, Clinicum, HUS Neurocenter |
| بيانات النشر: |
Frontiers Media |
| سنة النشر: |
2018 |
| المجموعة: |
Helsingfors Universitet: HELDA – Helsingin yliopiston digitaalinen arkisto |
| مصطلحات موضوعية: |
ischemic stroke, thrombolysis, endovascular therapy, mechanical thrombectomy, intraarterial therapy, Solitaire stent retriever device, CT perfusion, randomized trial, STENT-RETRIEVER THROMBECTOMY, RANDOMIZED CONTROLLED-TRIAL, INTRAARTERIAL TREATMENT, IMAGING SELECTION, THERAPY, TIME, THRACE, DALYS, 3112 Neurosciences, 3124 Neurology and psychiatry |
| الوصف: |
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 alteplaseonly 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. c Conclusion: Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had ... |
| نوع الوثيقة: |
article in journal/newspaper |
| وصف الملف: |
application/pdf |
| اللغة: |
English |
| العلاقة: |
Supported by grants from the National Health and Medical Research Council of Australia (1043242, Bruce Campbell Fellowships 1035688 and 1111972 co-funded by Heart Foundation of Australia, Dominique Cadilhac fellowship 1063761 co-funded by Heart Foundation of Australia), Royal Australasian College of Physicians, Royal Melbourne Hospital Foundation, Stroke Foundation of Australia. Solitaire FR device and trial infrastructure were supported by an unrestricted grant from Covidien (Medtronic) who had no role in study design, conduct or analysis.; Campbell , B C V , Mitchell , P J , Churilov , L , Keshtkaran , M , Hong , K-S , Kleinig , T J , Dewey , H M , Yassi , N , Yan , B , Dowling , R J , Parsons , M W , Wu , T Y , Brooks , M , Simpson , M A , Miteff , F , Levi , C R , Krause , M , Harrington , T J , Faulder , K C , Steinfort , B S , Ang , T , Scroop , R , Barber , P A , McGuinness , B , Wijeratne , T , Phan , T G , Chong , W , Chandra , R V , Bladin , C F , Rice , H , de Villiers , L , Ma , H , Desmond , P M , Meretoja , A , Cadilhac , D A , Donnan , G A , Davis , S M & EXTEND-IA Investigators 2017 , ' Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost ' , Frontiers in neurology , vol. 8 , 657 . https://doi.org/10.3389/fneur.2017.00657Test; ORCID: /0000-0001-6433-1931/work/40380594; 85038220351; 098f006e-f483-4dbb-aeb6-a6f80e39c036; http://hdl.handle.net/10138/230823Test; 000418062700001 |
| الإتاحة: |
http://hdl.handle.net/10138/230823Test |
| حقوق: |
cc_by ; openAccess ; info:eu-repo/semantics/openAccess |
| رقم الانضمام: |
edsbas.C5AC14F6 |
| قاعدة البيانات: |
BASE |
