Stebner Alexander, Cimflova Petra, Bosshart Salome L, Kunz Wolfgang G, Bhogal Pervinder, Hill Michael, Goyal Mayank, Ospel Johanna M
Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Clin Neuroradiol. 2025 Aug 28. doi: 10.1007/s00062-025-01524-5.
Incomplete reperfusion in endovascular thrombectomy (EVT) impacts patients' outcomes. Different incomplete reperfusion patterns may benefit from targeted therapeutic strategies, e.g. EVT-accessible incomplete reperfusion patterns could improve by performing additional EVT attempts, while EVT-non-accessible incomplete patterns might benefit from pharmacological therapies. The health-economic implications of these therapies are uncertain. This study aims to assess the potential economic benefits of improving incomplete reperfusion patterns after EVT.
Retrospective Data analysis from the ESCAPE-NA1 trial, which included patients with large vessel occlusion strokes undergoing EVT. Reperfusion patterns were classified as near-/complete (eTICI 2c3), EVT-accessible incomplete (eTICI 2b), or EVT-non-accessible incomplete (eTICI 2b) and we compared multiple attempts to achieve eTICI 2c3 vs. first-pass eTICI 2c3. A Markov-Model was built to compare lifetime costs and quality adjusted life-years (QALY) for each reperfusion pattern over a lifetime horizon, considering both healthcare and societal perspectives.
A total of 1105 of patients were enrolled in the ESCAPE-NA1 trial of which 949 with eTICI 2b, 2c and 3 were further analyized (mean age 70.7 ± 13.6 [SD]; 463 female). Near-Complete reperfusion (eTICI 2c3) was achieved in 506/1105 patients (45.8%). Incomplete reperfusion patterns (eTICI 2b) were found in 450/1105 (40.7%) patients. Angiography imaging could be further investigated in 443/450 (98.4%) cases with 147/443(33.2%) EVT-accessible and 296/443(66.8%) EVT-non-accessible incomplete reperfusion patterns. Compared to EVT-accessible and EVT-non-accssible incomplete reperfusion, achieving complete (eTICI 2c3) reperfusion resulted in lower costs and an additional 1.14/0.45 QALYs, making it the dominant strategy from a health-economic perspective. In the complete reperfusion (eTICI 2c3) group, cumulative lifetime QALYs were similar with 5.25 for single-pass eTICI 2c3 and 5.19 for multi-pass eTICI 2c3.
Improving incomplete reperfusion patterns after EVT has considerable potential health economic benefits, both in the presence and absence of a target occlusion that is amenable to EVT.
血管内血栓切除术（EVT）中再灌注不完全会影响患者的预后。不同的不完全再灌注模式可能从针对性治疗策略中获益，例如，可通过额外进行EVT尝试改善可通过EVT实现的不完全再灌注模式，而对于不可通过EVT实现的不完全模式，可能从药物治疗中获益。这些治疗的健康经济影响尚不确定。本研究旨在评估改善EVT后不完全再灌注模式的潜在经济效益。
对ESCAPE-NA1试验进行回顾性数据分析，该试验纳入了接受EVT的大血管闭塞性卒中患者。再灌注模式分为接近/完全（eTICI 2c3）、可通过EVT实现的不完全（eTICI 2b）或不可通过EVT实现的不完全（eTICI 2b），我们比较了多次尝试实现eTICI 2c3与首次通过eTICI 2c3的情况。构建了一个马尔可夫模型，从医疗保健和社会角度比较每种再灌注模式在一生时间范围内的终生成本和质量调整生命年（QALY）。
共有1105例患者纳入ESCAPE-NA1试验，其中949例eTICI 2b、2c和3的患者被进一步分析（平均年龄70.7±13.6[标准差]；463例女性）。506/1105例患者（45.8%）实现了接近完全再灌注（eTICI 2c3）。450/1105例（40.7%）患者发现不完全再灌注模式（eTICI 2b）。在450例中的443例（98.4%）病例中可进一步研究血管造影成像，其中147/443例（33.2%）为可通过EVT实现的不完全再灌注模式，296/443例（66.8%）为不可通过EVT实现的不完全再灌注模式。与可通过EVT实现的和不可通过EVT实现的不完全再灌注相比，实现完全（eTICI 2c3）再灌注可降低成本，并额外增加1.14/0.45个QALY，从健康经济角度来看，这使其成为主导策略。在完全再灌注（eTICI 2c3）组中，单次通过eTICI 2c3的累积终生QALY为5.25，多次通过eTICI 2c3的累积终生QALY为5.19，两者相似。
改善EVT后的不完全再灌注模式具有相当大的潜在健康经济效益，无论是否存在适合EVT的目标闭塞。
