Background

Although observational studies have reported favorable clinical outcomes associated with intra-arterial thrombolysis as adjunct to mechanical thrombectomy, the cost and length of hospitalization associated with this intervention has not been studied.

Methods

We analyzed the nationally representative data of the United States data from Nationwide Inpatient Sample (NIS) to compare hospitalization cost and duration in addition to other outcomes in patients receiving (n = 1990) with those not receiving intra-arterial thrombolysis (n = 1990) in acute ischemic stroke patients undergoing mechanical thrombectomy using a case control design matched for age, gender, and presence of aphasia, hemiplegia, neglect, coma/stupor, hemianopsia and dysphagia.

Results

There was no difference in the median hospitalization cost in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: $36,992 [28,361 to 54,336] versus $35,440 [24,383 to 50,438], (regression coefficient 2,485 [-1,947 to 6,917], p = 0.27). There was no difference in the median length of hospitalization in patients treated with intra-arterial thrombolysis compared with those not treated with intra-arterial thrombolysis: 6 days [3 to 10] versus 6 days [4 to 10], (regression coefficient -0.34 [-1.47 to 0.80], p = 0.56). There was no difference in odds of home-discharge (OR 1.02 95%CI 0.72-1.43, p = 0.93) or post-procedural intracranial hemorrhage (OR 1.16 95%CI 0.83-1.64, p = 0.39) between the two groups.

Conclusions

We did not observe an increase in the cost or length of hospitalization associated with the use of intra-arterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients. If the ongoing randomized clinical trials demonstrate therapeutic efficacy in reducing death or disability, this intervention has a high likelihood of being beneficial overall.

中文翻译：

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美国急性缺血性卒中患者动脉内溶栓辅助机械血栓切除术：病例对照分析

背景

尽管观察性研究报告了动脉内溶栓作为机械血栓切除术的辅助治疗的良好临床结果，但尚未研究与这种干预相关的住院费用和住院时间。

方法

我们分析了全国住院患者样本 (NIS) 中具有全国代表性的美国数据，以比较接受动脉溶栓治疗的患者 (n = 1990) 和未接受动脉内溶栓治疗的患者 (n = 1990) 的住院费用和持续时间 以及其他 结局在接受机械血栓切除术的急性缺血性中风患者中，使用与年龄、性别和失语、偏瘫、忽视、昏迷/昏迷、偏盲和吞咽困难的存在相匹配的病例对照设计。

结果

接受动脉内溶栓治疗的患者与未接受动脉内溶栓治疗的患者的中位住院费用没有差异：36,992 美元 [28,361 至 54,336] 与 35,440 美元 [24,383 至 50,438]，（回归系数 2,485 [-1,947 至6,917]，p  = 0.27）。与未接受动脉溶栓治疗的患者相比，接受动脉溶栓治疗的患者的中位住院时间没有差异：6 天 [3 至 10] 对比 6 天 [4 至 10]，（回归系数 -0.34 [-1.47 至 0.80]，p  = 0.56）。出院率 (OR 1.02 95%CI 0.72-1.43, p  = 0.93) 或术后颅内出血 (OR 1.16 95%CI 0.83-1.64, p = 0.39) 两组之间。

结论

我们没有观察到与使用动脉内溶栓作为急性缺血性卒中患者机械血栓切除术的辅助治疗相关的费用或住院时间的增加。如果正在进行的随机临床试验证明在减少死亡或残疾方面具有疗效，那么这种干预很可能总体上是有益的。