Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
World Neurosurg. 2024 Mar;183:e495-e501. doi: 10.1016/j.wneu.2023.12.129. Epub 2023 Dec 28.
A direct-aspiration first-pass technique (ADAPT) in mechanical thrombectomy has been described in recent studies as an efficacious strategy compared with using a stent retriever (SR). We sought to evaluate for cost differences of ADAPT technique versus SR as an initial approach.
We conducted a retrospective analysis of consecutive patients with mechanical thrombectomy at our institution between 2022 and 2023. Patients were grouped into ADAPT with/without SR as a rescue strategy and SR as an initial approach with allowance of concomitant aspiration. Direct cost data (consumables) were obtained. Baseline demographics, stroke metrics, procedure outcomes and cost, and last follow-up outcomes in modified Rankin Scale were compared between 2 groups.
Fifty-six patients were included. Thirty-seven (66.1%) underwent ADAPT, with 11 (29.7%) eventually requiring an SR. Mean age was 64.8 years. The average National Institutes of Health Stroke Scale score was 13.2 in the ADAPT group and 14.0 in the SR group (P = 0.68), with a similar proportion of tissue plasminogen activator (P = 0.53), site of occlusion (P = 0.66), and tandem occlusion (P = 0.69) between the 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 2 groups. Significantly lower cost (P < 0.01) was observed in ADAPT ($14,243.4) compared with 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 (modified Rankin Scale score <3) with no difference (P = 0.56) between the ADAPT (59.5%) and SR (47.4%) groups.
Outcomes were comparable between the ADAPT and SR groups. ADAPT reduced procedural consumables cost by approximately $5000 (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.
在最近的研究中，与使用支架取栓器（SR）相比，机械血栓切除术的直接抽吸首过技术（ADAPT）被描述为一种有效的策略。我们旨在评估 ADAPT 技术与 SR 作为初始方法的成本差异。
我们对 2022 年至 2023 年在我们机构接受机械血栓切除术的连续患者进行了回顾性分析。将患者分为 ADAPT 联合/不联合 SR 作为挽救策略和 SR 作为初始方法，允许同时抽吸。获得直接成本数据（耗材）。比较两组间基线人口统计学、卒中指标、手术结果和成本以及最后随访改良 Rankin 量表的结果。
共纳入 56 例患者。37 例（66.1%）接受 ADAPT 治疗，其中 11 例（29.7%）最终需要使用 SR。平均年龄为 64.8 岁。ADAPT 组的平均国立卫生研究院卒中量表评分为 13.2，SR 组为 14.0（P=0.68），组织型纤溶酶原激活物的比例相似（P=0.53），闭塞部位（P=0.66）和串联闭塞（P=0.69）。所有患者的再通率均达到 94.6%，平均再通次数为 1.9 次，89.3%为 TICI 2B 或以上，两组间无差异。ADAPT 组的成本明显降低（P<0.01）（$14,243.4）与 SR 组（$19,003.6）。平均随访时间为 180.2 天，死亡率为 23.2%。末次随访时，55.4%的患者功能独立（改良 Rankin 量表评分<3），ADAPT 组（59.5%）和 SR 组（47.4%）之间无差异（P=0.56）。
ADAPT 组和 SR 组的结果相当。即使允许使用支架取栓器进行挽救，ADAPT 也可降低约 5000 美元（25%）的手术耗材成本。确立 ADAPT 作为初始方法可能会带来显著的直接成本节约，同时获得相似的结果。
