Using CT angiography (CTA) to screen for large vessel occlusion in patients with acute minor stroke is not only cost-effective, but is also associated with improved outcomes.
That’s according to a new analysis of three different patient management strategies published Jan. 14 in Radiology. CTA followed immediately by thrombectomy proved to be the cheapest option and yielded the most quality-adjusted life years, Xiao Wu, with Yale School of Medicine, and colleagues reported.
“Our study findings emphasize the utility of early CT angiographic detection of LVO (large vessel occlusion) to improve health outcomes and reduce overall costs,” the researchers added.
Endovascular thrombectomy has “revolutionized” the management and treatment of stroke patients with LVO. This specific population is associated with higher risk of worsening condition, as well as more adverse outcomes. Under current guidelines, however, CTA imaging and subsequent thrombectomy are only recommended for certain groups and may overlook those with milder symptoms. This, the authors argue, can result in many missed cases in which endovascular thrombectomy would have been beneficial.
These missed cases apply specifically to patients assigned a National Institutes of Health Stroke Scale (NIHSS) score of 6 or less. The score refers to the severity of a stroke based on a number of clinical findings.
Wu and colleagues created a decision-analytic model to evaluate three management approaches: (1) no vascular imaging and best medical management; (2) CT angiography for all patients and immediate thrombectomy for LVO after intravenous thrombolysis; and (3) CT angiography for all and best medical management (including intravenous thrombolysis with rescue thrombectomy for patients with LVO and neurologic deterioration). The scenario was run on a 65-year-old patient with a minor stroke (NIHSS score of less than 6).
Overall, CTA with immediate thrombectomy for LVO had the lowest cost ($346,007) and highest health benefit of 9.26 quality-adjusted life years in patients with minor stroke.
Until now the cost-effectiveness of this approach was unproven. Given the evidence, however, this care strategy could help the 30% of patients with minor stroke whose LVO could be detected in specialized centers, the authors noted.
“In conclusion, screening for large-vessel occlusion with CT angiography in patients with acute minor stroke was cost-effective,” the authors wrote. "The costs incurred in faster and better selection of patients for mechanical thrombectomy must be seen in the overall context of cost savings from better outcomes,” they added.