Mechanical thrombectomy for acute ischemic stroke
No clear cut conclusions can be drawn in terms of adverse effects related to thrombectomy. Organisation:1. There are arguments for both a decentralised and a centralised health care organisational model for acute stroke care depending on whether focus is on thrombolysis or thrombectomy, and local co...
| Main Authors: | , , , |
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| Corporate Author: | |
| Format: | eBook |
| Language: | English |
| Published: |
Oslo
National Institute of Public Health, Division of Health Services
2016, 2016
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | No clear cut conclusions can be drawn in terms of adverse effects related to thrombectomy. Organisation:1. There are arguments for both a decentralised and a centralised health care organisational model for acute stroke care depending on whether focus is on thrombolysis or thrombectomy, and local conditions.2. If the intention is to provide equal stroke care, establishing more intervention centres, developing pre-hospital health services and collaboration between regions, as well as neighboring countries should be considered. Health economy:1. Costs associated with thrombectomy as additional treatment to thrombolysis covering procedure, diagnostic imaging and transport are estimated to 84,331 NOK (range: 51,631-192,631 NOK). Important ethical issues are related to:1. The principle of access to equal health care services2. Patients' autonomy, particularily when the stroke has led to decreased decision-making capacity Clinical effects and safety: Available research documentation on the use of mechanical thrombectomy as additional treatment to standard therapy (thrombolysis) compared to standard therapy alone shows that:1. No certain difference between the two therapeutic options in terms of mortality assessed after 90 days2. The risk of of functional loss is decreased with thrombectomy3. Health-related quality of life assessed after 65-90 days is probably better following thrombectomy, but the quality of evidence is low4. Assessed 24-30 hours after treatment, there might be increased risks of haemorrhages (both symptomatic and non-symptomatic ones) following thrombectomy, however there is no significant difference when symptomatic intracranial haemorrhages are analysed separately,5. Risks for recurrent strokes at 90 days are possibly higher after thrombectomy, but this is uncertain due to low quality of the evidence,6. Each year around 10,000 patients are treated for severe acute stroke at Norwegian hospitals. Whereas many patients die, survivors often suffer from considerable loss of function. Mechanical thrombectomy is a treatment option for large vessel ischemic stroke. Thrombectomy consists in physically removing the obstructing clot (thrombe) using specific for-purpose designed devices. The method is used when standard treatment (thrombolysis) has failed to dissolve the thrombe, or is contraindicated. In Norway, thrombectomy is performed at specific intervention centres. However, time is a crucial factor, as the intervention is recommended maximum 6 hours following the stroke. Thus implementation of this method at the national level, i.e. being available to all citizens, will meet important challenges due to the particular population distribution, topography and weather conditions in large parts of our country. |
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| Item Description: | English summary excerpted from full report in Norwegian: Mekanisk trombektomi ved akutt hjerneinfarkt. - Excerpt from Report 2016-15 |
| Physical Description: | 1 PDF file (pages 11-19) |
| ISBN: | 9788280827449 |