Deans' stroke musings: Cost Effectiveness of a Direct Aspiration First Pass Technique (ADAPT) Versus Stent-Retriever in Mechanical Thrombectomy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, December 29, 2023

Cost Effectiveness of a Direct Aspiration First Pass Technique (ADAPT) Versus Stent-Retriever in Mechanical Thrombectomy

'Costs'?

Survivors want to know the effectiveness of getting to 100% recovery. Work on what survivors want instead of 'cost'!

What absolute fucking stupidity! Survivors don't care about costs you blithering idiots! They want to know your 100% recovery statistics. GET THERE!

WRONG, WRONG, WRONG! Survivors don't care about cost, they want effectiveness. How close does this get them to 100% recovery? Are you that blitheringly stupid?

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https://doi.org/10.1016/j.wneu.2023.12.129 Get rights and content

ABSTRACT

Introduction

A direct aspiration first pass technique(ADAPT) in mechanical thrombectomy(MT) has been described in recent studies as an efficacious strategy compared to stent retriever(SR). We sought to evaluate for cost differences of ADAPT technique versus SR as an initial approach.

Methods

Retrospective analysis of consecutive patients with MT at our institution between 2022-2023. Patients were grouped into ADAPT with/without SR as rescue strategy, and SR as an initial approach with allowance of concomitant aspiration. Direct cost data(consumables) was obtained. Baseline demographics, stroke metrics, procedure outcomes and cost, last follow-up outcomes in modified Rankin Scale(mRS) were compared between two groups.

Results

56 patients were included. Thirty-seven(66.1%) underwent ADAPT, with 11(29.7%) eventually requiring an SR. Mean age was 64.8 years. Average NIHSS score was 13.2 in the ADAPT group and 14.0 in the SR group(p=0.68), with similar proportion of tPA(p=0.53), site-of-occlusion (p=0.66), and tandem occlusion(p=0.69) between groups. Recanalization was achieved in 94.6% of all patients, with an average of 1.9 passes, 89.3% being TICI 2B or above, with no differences between the two groups. Significantly lower cost(p<0.01) was observed in ADAPT($14,243.4) compared to SR($19,003.6). Average follow-up duration was 180.2 days, with mortality of 23.2%. At last follow-up, 55.4% remained functionally independent(mRS<3) with no difference(p=0.56) between the ADAPT(59.5%) and SR(47.4%) groups.

Conclusion

Outcomes were comparable(What were they? 100% recovery?) between the ADAPT and SR groups. ADAPT reduced procedural consumables cost by approximately $5,000(25%), even if stent retrievers were allowed to be used for rescue. Establishing ADPAT as initial approach may bring significant direct cost savings while obtaining similar outcomes.