Alhamza R Al-Bayati

Background Balloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Evaluating the potential economic impact associated with adjunctive BGC use is an important consideration for resource allocation. Methods Decision tree models were used to estimate the economic value of BGC use in MT through its impact on functional outcomes. Healthcare utilization cost estimates in the short- and long-term for patients with different 90-day mRS scores were analyzed for MT-only and MT + BGC scenarios. Deterministic (one-way) and probabilistic sensitivity analyses were performed to evaluate the robustness and uncertainty of model parameters. Results Per-patient index hospitalization cost was estimated at $65,260 for MT-only and $62,883 for MT + BGC scenarios. Per-patient one-year post-index hospitalization cost was estimated at $27,569 for MT-only and $24,830 for MT + BGC. MT + BGC had a total cost savings of $5117 compared with MT-only. Deterministic (one-way) sensitivity analysis demonstrated that cost saving per patient was most sensitive to the proportion of patients in the mRS 0–2 category in both MT + BGC and MT-only. In a probabilistic sensitivity analysis, mean per-patient costs for the index hospitalization were estimated at $63,737 for MT-only and $61,425 for MT + BGC. Mean per-patient cost estimates one-year post-index hospitalization was $27,445 for MT-only and $24,715 for MT + BGC. MT + BGC had a total cost savings of $5043 compared with MT-only. Conclusion Mechanical thrombectomy with adjunctive BGC use may reduce short-term and long-term patient costs due to improved functional outcomes when compared to MT treatment alone for AIS.

Introduction Computed tomography perfusion (CTP) has played an important role in patient selection for mechanical thrombectomy (MT) in acute ischemic stroke. We aimed to investigate the agreement between perfusion parametric maps of 3 software packages – RAPID (RapidAI‐IschemaView), Viz CTP(Viz.ai), and e‐CTP(Brainomix) – in estimating baseline ischemic core volumes of near completely/completely reperfused patients. Methods We retrospectively reviewed a prospectively maintained MT database to identify patients with anterior circulation large vessel occlusion strokes (LVOS) involving the internal carotid artery or middle cerebral artery M1‐segment and interpretable CTP maps treated during September 2018 to November 2019. A subset of patients with near‐complete/complete reperfusion (expanded thrombolysis in cerebral infarction [eTICI] 2c–3) was used to compare the pre‐procedural prediction of final infarct volumes. Results In this analysis of 242 patients with LVOS, RAPID and Viz CTP relative cerebral blood flow (rCBF) < 30% values had substantial agreement ( ρ = 0.767 [95% confidence interval [CI] = 0.71–0.81]) as well as for RAPID and e‐CTP ( ρ = 0.668 [95% CI = 0.61–0.71]). Excellent agreement was seen for time to maximum of the residue function ( T max ) > 6 seconds between RAPID and Viz CTP ( ρ = 0.811 [95% CI = 0.76–0.84]) and substantial for RAPID and e‐CTP ( ρ = 0.749 [95% CI = 0.69–0.79]). Final infarct volume (FIV) prediction (n = 136) was substantial in all 3 packages (RAPID ρ = 0.744; Viz CTP ρ = 0.711; and e‐CTP ρ = 0.600). Conclusion Perfusion parametric maps of the RAPID, Viz CTP, and e‐CTP software have substantial agreement in predicting final infarct volume in near‐completely/completely reperfused patients. ANN NEUROL 2023;94:848–855