Longer Thrombectomy Times Increase Mortality Risk and Stroke Care Costs

 What this means is that followup interventions need to be prioritized to get survivors fully recovered.  Change the failed status quo! Or is everyone in stroke completely BRAIN DEAD and willing to live with failure?

Longer Thrombectomy Times Increase Mortality Risk and Stroke Care Costs

Puncture to recanalization time was significantly associated with discharge outcome, wherein each 15-minute increase was linked to a higher likelihood of death or hospice discharge. Patients with acute ischemic stroke who experience longer puncture to recanalization (PTR) times during thrombectomy have worse outcomes and greater acute care costs. These findings were published in Stroke: Vascular and Interventional Neurology Researchers conducted a retrospective analysis of 721 patients who underwent mechanical thrombectomy for large vessel occlusion at a high-volume neuroendovascular practice between January 2011 and June 2020. The researchers examined the effect of PTR time on immediate poststroke disposition and associated costs. The analysis included patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction≥2B) and excluded those with missing data or those with extreme time outliers. Patients were categorized into 4 discharge groups: transfer to acute or subacute rehabilitation, home or home with physical therapy (PT), in-hospital death or hospice, and long-term care placement. The researchers employed a multinomial logistic regression model to assess how incremental increases in PTR time influenced these outcomes. [R]educing procedural time should be prioritized not only to improve individual patient outcomes but also to support institutional cost efficiency and inform national stroke care policies. The median PTR time was 34.7 minutes, and the cohort was 50% women, with a mean age of 67.0 years. Most patients (95%) presented with anterior circulation occlusions. Common comorbidities included hypertension (78.8%), hyperlipidemia (51.5%), atrial fibrillation (38.4%), and diabetes (29.3%). At discharge, 54.2% of patients were transferred to rehabilitation, 21.9% were discharged home or home with PT, 18.7% died or were transitioned to hospice, and 5.1% required long-term care placement. There was a significant association between PTR and discharge disposition (P= .003). Each 15-minute increase in PTR was linked to a 2% to 4.6% higher likelihood of death or hospice discharge and a 1.5% to 2.5% lower likelihood of being discharged home or home with PT. In adjusted analyses, longer PTR was independently associated with greater odds of death or hospice disposition (odds ratio [OR], 1.020; 95% CI, 1.008-1.032;P=.001). From an economic standpoint, every 15-minute increase in PTR was associated with an average increase in direct acute care costs of $190.04 per stroke episode (95% CI, $184.74-$196.20;P<.001). When extrapolated to an estimated 39,000 annual thrombectomies nationwide, the researchers estimated a $7.4 million annual increase in acute stroke care costs for each 15-minute increase in mean PTR (95% CI, $7.2–$7.7 million). Study limitations include a single-center design, exclusion of patients with incomplete data, and reliance on modeled cost estimates that did not capture postacute or indirect costs. “These results suggest that procedural speed remains a crucial determinant of clinical outcome, and reducing procedural time should be prioritized not only to improve individual patient outcomes but also to support institutional cost efficiency and inform national stroke care policies,” the study authors concluded.  Disclosures: This research was supported by Microvention. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.