Conference News Update—Society of Neurointerventional Surgery
Other studies support the need for MSTUs. In the ESCAPE study earlier this year, researchers found that routing patients directly to a comprehensive stroke center may significantly decrease patient wait time for treatment.
Certain Stroke Treatments Reduce Health Care Costs
Using mechanical thrombectomy on qualifying patients with stroke could result in major savings to the healthcare economy in the United Kingdom and other Western countries with similar healthcare structures, according to researchers.
The study, Developing an Interventional Stroke Service: Improving Clinical Outcomes and Reducing Cost and Delivering Great Cost Savings Benefits to Health Economy, which was conducted at the University Hospital of North Midlands in Stoke-on-Trent, UK, found that mechanical thrombectomy in the treatment of stroke reduced the average patient’s hospital stay to 14 days, compared with a previously recorded time of 90 days. In addition, more than nine in 10 patients were discharged to their homes, as opposed to a nursing home. Using these data, the researchers also found that mechanical thrombectomy produced a net savings of £3.2 million (approximately $5 million), or £684,000 (approximately $1.1 million) per 100,000 people served. The investigators estimated that from 20,000 to 25,000 potential patients could receive mechanical thrombectomy in the UK if the intervention were used as a mainstream treatment for large-vessel clots.
“It’s quite amazing that this treatment can make such a notable impact, both medically and economically,” said Sanjeev Nayak, MD, the lead author of the study and a neurointerventionalist at the University Hospital of North Midlands. “Not only are we seeing patient mortality and time in the hospital reduced dramatically when treating large-vessel clots with mechanical thrombectomy, but we are saving money in the process. This procedure shows strong benefit, both for eligible patients and our healthcare system as a whole.”
While t-PA had been the only medical therapy approved for the treatment of acute stroke in the United States, the projected UK cost savings of mechanical thrombectomy treatment, as reported in the study, could potentially occur in the US.
Tools for Selecting Patients for Aneurysm Treatment Need Further Evaluation
Research indicates that strict adherence to two commonly used tools to weigh the risk of treating unruptured aneurysms may not prevent the majority of morbidity or mortality outcomes associated with ruptured intracranial aneurysms. The International Study of Unruptured Intracranial Aneurysms (ISUIA) criteria and the PHASES score thus require additional research to determine their effectiveness.
Published in 2003, the ISUIA study predicted the risk of aneurysmal rupture based primarily upon the size and site of the aneurysm. Posterior circulation aneurysms larger than 7 mm were reported as having the highest rupture risk when compared with their counterparts in the anterior circulation. A decade later, the PHASES score was developed to calculate aneurysmal rupture risk based upon a myriad of factors, including the patient population, history of hypertension, age, size of aneurysm, history of earlier subarachnoid hemorrhage (SAH), and site of aneurysm. With this tool, a cumulative score of 8 predicts a five-year risk of rupture of 3.2%.
In the study titled A Re-Evaluation of the ISUIA Criteria and the PHASES Score for Predicting Intracranial Aneurysmal Rupture, these standard results were compared with an analysis of 520 ruptured aneurysms from an institutional database that had been treated at Emory University Hospital in Atlanta. The study’s results conflicted with those of ISUIA. For example, the investigators found that approximately 77% of ruptured aneurysms measured smaller than 7 mm in their largest diameter, regardless of location in either the anterior or posterior circulations. When comparing their data to that of PHASES, the researchers observed that approximately 90% of study patients received a score of less than 8, thus putting their predicted five-year risk of rupture at 3.2%.
“Despite the fact that ISUIA and PHASES standards are widely accepted and used within the field, it is important that we continue to re-evaluate them and compare them with the data and experience at large academic centers,” said Arsalaan Salehani, lead study author and fourth-year medical student at Emory University School of Medicine.
“As our database grows, we plan to continually reanalyze our findings not only to broadly contribute to the academic community, but to ultimately ensure that physicians are using the best criteria and guidelines when making decisions about patient selection for treatment,” said Adds Raul Nogueira, MD, Neuroendovascular Division Director at Grady Memorial Hospital.
