Mechanical thrombectomy after stroke

Strokes are the leading cause of death worldwide[1] and account for approximately 140,000 deaths in the United States each year[2]. As healthcare professionals, it is very important that we educate patients and their caregivers on the importance of seeking timely treatment during a stroke, as well as sharing the benefits of these treatments with the medical community. .

Every minute during a stroke, 1.9 million brain cells are lost.[3] Therefore, time is equal to brain cells – and the time before receiving treatment has a direct impact on a person’s likelihood of recovery. Advances in stroke research over the past decade have led to innovative and effective treatments, such as mechanical thrombectomy, which is a minimally invasive procedure that offers positive benefits to patients after ischemic stroke if applied in the first few hours after the start of the stroke.

Health economic impacts of first-pass success during mechanical thrombectomy

Mechanical thrombectomy (MT) is an effective procedure that helps improve a patient’s chances of surviving a stroke and making a full recovery, with more than half of patients regaining functional independence.[4]

However, although mechanical thrombectomy can be a life-saving treatment, not all procedures are created equal. When the procedure achieves substantial or excellent restoration of blood flow to the brain on the first pass, patients reap the greatest benefits.[5]

Restoration of first-pass blood flow is the procedural goal in the endovascular treatment of acute ischemic stroke and may reduce the risk of endothelial vessel injury, reduce the complication rate, and shorten the procedure time.[5] A recent CERENOVUS study, published in the Journal of NeuroInterventional Surgery, demonstrates the cost savings associated with first-pass success in mechanical thrombectomy for the treatment of acute ischemic stroke in the United States and Europe.[6] The study found that it significantly reduced healthcare costs in the first year after an ischemic stroke and that first-line treatment for large-volume occlusion ischemic stroke should ideally involve a TM technique that offers the best chances of success on the first pass. (Table).[6]

Specific findings of the study include:

  • Significantly earlier hospital discharge, with length of stay reduced from nearly 10 days to 6 days
  • Potential savings per patient during the intensive care phase in hospital (from $6,575 in the United States and €1,560 in France)
  • Beyond hospitalization, additional savings are expected in the first year after stroke (from $4,116 in the US and €823 in Italy)

Stroke places a heavy burden on healthcare systems around the world, in addition to the devastation it can cause to patients and their loved ones. This study shows that restoring first-pass blood flow gives patients, healthcare systems and healthcare professionals the best possible chance of overcoming the major challenges that a stroke can present.

Efforts to increase the use of mechanical thrombectomy

While TM has transformed the first-line treatment for ischemic stroke, which accounts for 85% of all strokes,[7] it is often underused, with less than 20% of Americans having direct access to centers that can perform the procedure.[8]

All stroke patients should ideally be treated in a Level 1 stroke center, which offers a full range of neuroendovascular care and specialist care teams available 24/7. Yet, until recently, many patients were not referred to these specialized centers because triage and patient transport protocols were outdated or non-existent. However, advocacy organizations like Get ahead of stroke have worked to educate the public and policy makers on the importance of stroke center designations. This work helped inform the recent publication of the new National Model EMS Clinical Guidelineswhich now include guidelines to help direct all states and localities to triage, transport and treatment protocols that best meet the needs of patients after stroke.

Everyone in the healthcare community has a role to play in raising awareness of prompt and effective stroke treatment, from healthcare professionals to patients to emergency responders. The sooner treatment such as TM is received, the higher a patient’s chance of survival and ability to return to life without disability.

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