Health Economic Impact of Incomplete Reperfusion Patterns After Endovascular Thrombectomy in Acute Ischemic Stroke.

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Clinical Neuroradiology Pub Date : 2026-03-01 Epub Date: 2025-08-28 DOI:10.1007/s00062-025-01524-5

Alexander Stebner, Petra Cimflova, Salome L Bosshart, Wolfgang G Kunz, Pervinder Bhogal, Michael Hill, Mayank Goyal, Johanna M Ospel

{"title":"Health Economic Impact of Incomplete Reperfusion Patterns After Endovascular Thrombectomy in Acute Ischemic Stroke.","authors":"Alexander Stebner, Petra Cimflova, Salome L Bosshart, Wolfgang G Kunz, Pervinder Bhogal, Michael Hill, Mayank Goyal, Johanna M Ospel","doi":"10.1007/s00062-025-01524-5","DOIUrl":null,"url":null,"abstract":"Background and purpose: 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.Materials and methods: 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.Results: 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.Conclusions: 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.","PeriodicalId":49298,"journal":{"name":"Clinical Neuroradiology","volume":" ","pages":"93-102"},"PeriodicalIF":3.2000,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009091/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00062-025-01524-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and purpose: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

Abstract Image

查看原文本刊更多论文

急性缺血性卒中血管内取栓术后不完全再灌注模式对健康经济的影响。

背景与目的：血管内取栓术（EVT）不完全再灌注影响患者预后。不同的不完全再灌注模式可能受益于有针对性的治疗策略，例如，EVT可达的不完全再灌注模式可以通过进行额外的EVT尝试来改善，而EVT不可达的不完全再灌注模式可能受益于药物治疗。这些疗法对健康经济的影响尚不确定。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。材料和方法：ESCAPE-NA1试验的回顾性数据分析，该试验纳入了接受EVT治疗的大血管闭塞性卒中患者。再灌注模式被分类为接近/完全（eTICI 2c3）、evt可达不完全（eTICI 2b）或evt不可达不完全（eTICI 2b），我们比较了多次尝试实现eTICI 2c3和首次eTICI 2c3。在考虑医疗保健和社会观点的情况下，建立马尔可夫模型来比较生命周期内每种再灌注模式的生命周期成本和质量调整生命年（QALY）。结果：ESCAPE-NA1试验共纳入1105例患者，其中949例eTICI 2b、2c和3被进一步分析（平均年龄70.7 ±13.6 [SD]；女性463例）。506/1105例患者（45.8%）实现了近完全再灌注（eTICI 2c3）。450/1105例（40.7%）患者发现不完全再灌注模式（eTICI 2b）。有147/443(33.2%)evt可达和296/443(66.8%)evt不可达的不完全再灌注模式的患者中，有443/450（98.4%）例可进一步进行血管造影检查。与evt可及和evt不可及的不完全再灌注相比，实现完全（eTICI 2c3）再灌注可降低成本和额外的1.14/0.45 qaly，从健康经济学角度来看，这使其成为主导策略。在完全再灌注（eTICI 2c3）组，累积寿命QALYs相似，单次eTICI 2c3组为5.25，多次eTICI 2c3组为5.19。结论：改善EVT后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的靶闭塞。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

5.00

自引率

3.60%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.