Deans' stroke musings: The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory

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.

Thursday, March 28, 2024

The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory

A breathless tweet from @JNIS_BMJ: BREAKTHROUGH in Stroke Treatment! Meta-analysis: Mechanical Thrombectomy >> Medical Management for large infarct stroke! ++ functional recovery & quality-adjusted life-years PLUS more cost-effective over life.

You can decide how breakthrough it is; I don't see full 100% recovery for all!

The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory

http://orcid.org/0000-0001-8797-0808Assala Aslan1,
Saad Abuzahra1,
Nimer Adeeb2,
http://orcid.org/0009-0000-4910-6090Basel Musmar2,
http://orcid.org/0000-0002-5208-8425Hamza A Salim2,
Sandeep Kandregula3,
http://orcid.org/0000-0003-0131-5699Adam A Dmytriw4,5,
Christoph J Griessenauer6,
Luis De Alba1,
Octavio Arevalo1,
Jan Karl Burkhardt3,
Vitor M Pereira5,
http://orcid.org/0000-0002-1544-4910Pascal Jabbour7,
http://orcid.org/0000-0001-6668-6656Bharat Guthikonda2,
Hugo H Cuellar1,3

Correspondence to Dr Hugo H Cuellar, Department of Radiology and Interventional radiology, Ochsner-Louisiana State University, Shreveport, LA 71104, USA; hugo.cuellarsaenz@lsuhs.edu

Abstract

Background Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of <6).

Objective To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness associated with those treatments.

Methods A meta-analysis of the RESCUE-Japan, SELECT2, and ANGEL-ASPECT trials was conducted using R Studio. Statistical analysis employed the weighted average normal method for calculating mean differences from medians in continuous variables and the risk ratio for categorical variables. TreeAge software was used to construct a cost-effectiveness analysis model comparing MT with BMM in the treatment of ischemic stroke with large infarction territory.

Results The meta-analysis showed significantly better functional outcomes, with higher rates of patients achieving a modified Rankin Scale score of 0–3 at 90 days with MT as compared with BMM. In the base-case analysis using a lifetime horizon, MT led to a greater gain in quality-adjusted life-years (QALYs) of 3.46 at a lower cost of US$339 202 in comparison with BMM, which led to the gain of 2.41 QALYs at a cost of US$361 896. The incremental cost-effectiveness ratio was US$−21 660, indicating that MT was the dominant treatment at a willingness-to-pay of US$70 000.

Conclusions This study shows that, besides having a better functional outcome at 90-days' follow-up, MT was more cost-effective than BMM, when accounting for healthcare cost associated with treatment outcome.