Introduction: Rapid recanalization using intraarterial thrombectomy (IAT) is recommended to achieve rapid functional improvement and to shorten admission and rehabilitation period for acute ischemic stroke patients. We evaluated clinical and cost effectiveness of rapid recanalization within 6 hours by comparison with recanalization over 6 hours and no-recanalization of the occluded vessels in acute ischemic stroke patients.
Methods: We analyzed clinical outcomes and medical costs of 230 acute ischemic stroke patients, who received IAT from October 2010 to May 2015. Patients were classified into rapid- (<6 hrs, n=143) and late- (> 6hrs, n=31) recanalization (≥2b or 3 of Thrombolysis in Cerebral Infarction grade [TICI]), and no-recanalization (TICI ≤2a, n=56) groups by the recanalization status after IAT. Differences of functional independence defined as 0-2 modified Rankin Score and medical costs checked at discharge and 1 year after IAT were compared between three groups. We also evaluated quality-adjusted life year (QALY) using EQ-5D 3 level version at 1 year after IAT and compared mortality and cost-effectiveness differences between the groups using QALY.
Results: Functional independence was significantly higher in rapid-recanalization group than others at discharge (rapid-, 57%, vs. late-, 23% vs. no-recanalization, 0%, p<0.001) and after 1 year (70% vs. 40% vs. 6%, p<0.001). QALY (0.71±0.41 vs. 0.52±0.45 vs. 0.15±0.34, p<0.001) checked at 1 year was also higher in rapid-recanalization group than the others. Instead, one year mortality was lower in rapid-group than the others (10% vs. 17% vs. 43%, p<0.001). Medical cost of rapid-recanalization group was lower than other two groups at discharge ($9515 vs. $12711 vs. $12460, p<0.001) and after 1 year ($16753 vs. $21957 vs. $30718, p<0.001). On QALY adjusted cost-utility analysis, rapid-recanalization after IAT was more cost effective than late- ($27389/QALY) and no-recanalization ($51059/QALY) for acute ischemic stroke patients.
Conclusions: The present data showed the importance of rapid recanalization within 6 hrs of acute ischemic stroke patients using IAT to reduce economic burden by the enhancement of functional outcomes during admission and after discharge.