Authors' results and conclusions: Six trials investigating the safety and effectiveness of stent retrievers for clot retrieval in ischaemic stroke were published in 2015. Five of the six were stopped early for efficacy. Although this brief is not a systematic review, the results as presented support mechanical thrombectomy in appropriately selected patients. Utilisation of the therapy relies on adequate infrastructure (such as imaging) and highly skilled personnel. Noting that the technology is already widely diffused across (tertiary) centres in all Australian states, HealthPACT sought to clarify the cost impact/utility of this intervention within the appropriate clinical cohort.

Authors' recommendations: The evidence to date demonstrates a clear benefit in terms of recovery time and functional outcomes for the small proportion (up to 10%) of acute ischaemic stroke patients who satisfy the inclusion criteria for both pharmacological thrombolysis and mechanical thrombectomy. This procedure should only be offered as part of comprehensive stroke, neuro-intervention and imaging services. HealthPACT notes that whilst the studies focused on clot retrieval, to impact upon longer term outcomes, at a system level consideration of insitu processes and pathways for early detection and intervention for stroke, referral pathways (which may include formal linkages between paramedic services and receiving emergency departments) and ongoing medical management of the patient following clot retrieval is required. Significantly, as 10% of patients suffering a transient ischaemic attack (TIA) progress to develop a major cerebrovascular accident (CVA) within 7-10 days, morbidity may be avoided if stroke management were pre-empted at the initial TIA presentation. Addressing such system issues would also improve stroke care for the some 90% of CVA patients who would not be eligible for clot retrieval. HealthPACT supports the adoption of this technology into clinical practice noting that a service such as this is currently limited by the number of trained and credentialed neuro-interventionalists capable of performing this highly specialised procedure. In addition, whilst attention has focused upon access to neuro-interventionalists, the delivery of this service also requires dedicated stroke physicians, neurosurgeons, neurological and neuro-radiology nurses and specialist imaging technicians. In order to provide this service on a 24-hour basis health services would need to undertake the required service and workforce planning.

Project Status: Completed

Year Published: 2015

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)