[Endovascular treatment of cerebrovascular disease]

Cerezo Espinosa de los Monteros JJ, Villegas Portero R, Garcia Mochon L,Orly de Labry Lima A, Bermudez Tamayo C
Record ID 32010000798
Authors' results and conclusions: Carotideal territory: A Cochrane Review has been updated and one randomised, controlled clinical trial has been found. No differences were seen in the main results, such as mortality and major stroke, for the two treatment groups.Intracranial territory: Two series of multi-centre groups with prospective data collection have been included. There is a lack of studies comparing endovascular treatment with medical regimens. The endovascular treatment was the dominated strategy for the population groups of all patients, and when low-risk patients were considered separately. Likewise, for high-risk patients, ICER of endovascular treatment was of 20,188.21€.The univariate sensitivity analysis, changing the costs of both interventions, resulted in that: for low-risk patients, the endovascular treatment stops being dominated when the cost of endarterectomy is of 5,640.14€. In high-risk patients, endarterectomy passes to be a dominated strategy when the cost of endarterectomy is over 5,567€ or the cost of the endovascular treatment is under 4,440€. For all patients, the endovascular treatment stops being dominated and passes to be dominant to endarterectomy only when the cost of endarterectomy is of 5,535.70€. In all cases, there was uncertainty concerning OR, since it was not statistically significant.
Authors' recommendations: Given the limited quality of the scientific evidence available, care should be taken when recommending changes to clinical practice and increasing the use of endovascular techniques.The reviewed studies reveal a trend towards no differentiation between the two carotideal approaches.Of the intracranial techniques, there is currently no scientific evidence comparing the results of endovascular treatment and medical care alone.The cost-effectiveness analysis on both interventions to treat cerebrovascular lesions, taking healthy and stroke-free cases per year after treatment as effectiveness measure, reported that endovascular intervention was an alternative dominated by endarterectomy for lowrisk patients and when all patients are considered. For high-risk patients, ICER of endovascular treatment was of 20,188.21€. There remains uncertainty concerning the Odds Ratio, since it was not significant for none of the population groups that had been onsidered.If carotid endarterectomy is not possible, endovascular treatment is an option. Similarly, for the intracranial territory, if a patient is reluctant to medical treatment endovascular intervention can be used.The uncertainties surrounding efficacy and safety advice to get the patient especially involved in the decision-making.
Project Status: Completed
Year Published: 2009
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Neurosurgical Procedures
  • Vascular Surgical Procedures
Organisation Name: Andalusian Health Technology Assessment Area
Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309
Contact Name: aetsa.csalud@juntadeandalucia.es
Contact Email: aetsa.csalud@juntadeandalucia.es
Copyright: Andalusian Agency for Health Technology Assessment (AETSA)
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