Original Title: Trombectomía endovascular en ACV isquémico agudo

Authors' recommendations: Moderate-quality evidence suggests that mechanical endovascular thrombectomy, along with tissue plasminogen activator administration or not, compared with the tissue plasminogen activator in patients with acute ischemic stroke improves functional capacity and revascularization rate at 90 days, if administered within the first seven hours of symptom onset. No differences were observed between these interventions regarding symptomatic intracranial bleeding incidence as adverse event, or mortality assessed at 90 days. It is worth mentioning that most evidence comes from second generation thrombectomy devices. Evidence comparing first and second generation devices on effectiveness is inconsistent and there might not be clear differences regarding safety. The clinical practice guidelines surveyed recommend tissue plasminogen activator as the treatment of choice in patients with up to 4.5 hours of symptom onset, and mechanical thrombectomy as an alternative for those who have contraindication to receive thrombolysis or as an add-on with thrombolysis for large vessel occlusion. Also, they recommend second generation devices with or without tissue plasminogen activator, up to six or eight hours of symptom onset. As regards first generation devices, they describe that they may be used for selected case, although they are not defined. None of the coverage policies surveyed in Latin America mentions this technology for the indication assessed, whereas four high-income countries cover it in patients, even outside the time window mentioned, or when the tissue plasminogen activator is contraindicated. Most of these countries do not make a distinction as regards the thrombectomy device chosen, although the United Kingdom favors the use of second generation devices. No cost-effectiveness studies or budget impact studies were found for Argentina or Latin America. One economic assessment from the United Kingdom suggests that including mechanical endovascular thrombectomy devices would cause a high budget impact, but at long-term it might be associated with reductions in direct medical costs.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)