1. EP51* Burden of tough to retrieve clots in acute ischemic stroke: clinical and economic impact of increasing retrieval attempts in mechanical thrombectomy
- Author
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John Thornton, Jack Alderson, S Ikeme, Heather L. Cameron, and C Tong
- Subjects
medicine.medical_specialty ,business.industry ,Retrospective cohort study ,medicine.disease ,Odds ,Mechanical thrombectomy ,Emergency medicine ,Health care ,medicine ,Economic impact analysis ,business ,Stroke ,Interventional neuroradiology ,Neuroradiology - Abstract
Introduction Emerging data show an association between increased mechanical thrombectomy (MT) passes and poor outcomes in ischemic stroke. Clots that require ≥3 passes are more often tough, fibrin-rich thrombi than those retrieved within two passes. Aims To assess the clinical and economic burden of number of MT passes, we evaluated the odds of achieving successful reperfusion and functional independence in first pass, or 2–3 passes, compared to ≥4 passes. Methods A retrospective observational study was conducted on 857 cases treated with MT from the Irish National Thrombectomy database. Outcomes were 90-day functional independence (mRS 0–2) and successful reperfusion (mTICI 2b-3) stratified by number of passes (1; 2–3; and ≥4) with multivariable regression to adjust for confounding variables. A decision-tree economic model was informed by 90-day mRS: independent (0–2), dependent (3–5), or dead, with literature-derived annual healthcare costs by mRS. Results The odds of achieving successful reperfusion were significantly higher for 1 vs. ≥4 passes (OR 7.19, p Conclusion Odds of achieving good outcomes decline with MT passes, while care costs increase. Thrombectomy devices that improve interaction with tough clots for rapid and complete retrieval in fewer passes may improve clinical and economic outcomes. References Yoo AJ. Journal of Stroke 2017;19(2):121. Douglas A. JNIS 2020;12(6):557–562. Liebeskind DS. Stroke 2011;42(5):1237–1243. Abbasi M. Interventional Neuroradiology 2021;202115910199211009119. Siddiqui AH. Stroke 2021;52(Suppl_1):AP14–AP14. Garcia-Tornel A. Stroke 2019;50(7):1781–1788. Shireman TI. Stroke 2017;48(2):379–387. Disclosure Dr. Jack Alderson, Radiology, Beaumont Hospital. Prof. Dr. John Thornton, Neuroradiology, Beaumont Hospital. Consultancy for Johnson & Johnson, Perfuze and Microvention. Shareholder Perfuze. Cindy Tong and Shelly Ikeme are employees of Johnson & Johnson. Heather Cameron is an employee of EVERSANA, a consultant for Johnson & Johnson. This research is funded by Cerenovus – a company of Johnson & Johnson
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- 2021