Strokes are the leading cause of death globally and account for an estimated 140,000 deaths in the United States each year. As medical professionals, it’s very important that we educate patients and their caregivers about the importance of seeking timely treatment when experiencing a stroke, as well as share the benefits of these treatments with the medical community.
Every minute during a stroke, 1.9 million brain cells are lost. Therefore, time equals brain cells—and the lag time to receiving treatment directly impacts a person’s probability of recovery. Advancements in stroke research over the last decade have led to innovative and effective treatments, like mechanical thrombectomy, which is a minimally invasive procedure that offers positive benefits for patients after an ischemic stroke if applied in the first few hours after stroke onset.
Health Economic Impacts of First-Pass Success During Mechanical Thrombectomy
Mechanical thrombectomy (MT) is an effective procedure that helps improve the chances a patient will survive a stroke and make a full recovery, with more than half of patients regaining functional independence.
However, while mechanical thrombectomy can be a lifesaving treatment, not all procedures are created equal. When the procedure achieves substantial or excellent restoration of blood flow to the brain from the first pass, patients experience the greatest benefits.
Achieving restoration of blood flow at the first pass is the procedural goal in the endovascular treatment of acute ischemic stroke and can reduce the risk of endothelial vessel injury, lower the rate of complications, and shorten procedure time. A recent CERENOVUS study, published in the Journal of NeuroInterventional Surgery, demonstrates the cost savings associated with first pass success in mechanical thrombectomy for treating acute ischemic stroke in the US and Europe. The study found that this significantly reduces healthcare spending within the first year after ischemic stroke and that first-line treatment for large volume occlusion ischemic stroke should ideally involve a MT technique that provides the best chance of success in the first pass (Table).
Specific results from the study include:
- Significantly earlier hospital discharge, with length of stay reduced from almost 10 days to 6 days
- Potential per-patient cost savings during the critical care phase in the hospital (from $6,575 in the US and €1,560 in France)
- Beyond hospitalization, additional cost savings are projected in the first year after stroke (from $4,116 in the US and €823 in Italy)
Stroke places a huge burden on health systems across the world, in addition to the devastation it can cause for patients and their loved ones. This study shows that achieving blood flow restoration at the first pass gives patients, healthcare systems, and healthcare professionals the best possible chance of overcoming the major challenges that a stroke can present.
Efforts to Increase Mechanical Thrombectomy Utilization
While MT has transformed first-line stroke treatment for ischemic stroke, which account for 85% of all strokes, it is often underutilized, with less than 20% of Americans having direct access to centers that can perform the procedure.
All patients who have had a stroke should ideally be treated at a Level 1 stroke center, which offer a full spectrum of neuroendovascular care and specialized care teams available 24/7. Yet, up until recently, many patients were not sent to these specialty centers because protocols for triaging and transporting patients were out-of-date or non-existent. However, advocacy organizations like Get Ahead of Stroke have been working to educate the public and policy makers on the importance of stroke center designations. This work has helped to drive the recent publication of the new National Model EMS Clinical Guidelines, which now include guidelines to help steer all states and localities toward triage, transport, and treatment protocols that best meet the needs of patients after a stroke.
All members of the healthcare community have a role to play in raising awareness of timely and effective treatment for stroke, from healthcare professionals to patients to emergency responders. The faster a treatment like MT is received, the higher a patient’s chance are of survival and the ability to return to life without disability.