Catheter treatment is not only effective, but also cost-effective for ischemic stroke

With ischemic stroke, every minute counts. However, many patients do not seek hospital care until it is too late, for example, because symptoms are not immediately recognized or because people wake up with signs of neurological deficits. As a result, a group of patients is no longer eligible for catheter treatment. 

In her doctoral research, Floor Pinckaers investigated whether catheter treatments might still be an option for this group of patients and whether these treatments are ultimately cost-effective.

Catheter treatment

An ischemic stroke occurs when a blood clot blocks a blood vessel in the brain. As a result, the brain tissue behind it no longer receives oxygen. This can result in the death of brain tissue. With catheter treatment, a tube is inserted through the groin to remove the blood clot. Since the proven effectiveness of this technique in the MR CLEAN study in 2014, this treatment has been applied within 6 hours of the onset of neurological deficits. “This really was a revolution in the medical world,” Floor explains. Before this, it was only possible to administer a medication that dissolves the blood clot. However, this is not always effective.

The moment of the ischemic stroke is simply not always known. “Sometimes patients already wake up with neurological deficits, and then it is not possible to determine when the stroke occurred,” Floor explains. To investigate whether this group of patients could also benefit from catheter treatment, the MR CLEAN-LATE study was set up. This study therefore focused on the group of patients who only report between 6 and 24 hours after the onset of the first symptoms or the last known time without symptoms. These studies form an important part of Floor’s PhD research.

According to Floor, not all patients who present later can still be treated with a catheter procedure. This selection of patients is made using brain imaging. “CT scans reveal, among other things, collaterals. These are the blood vessels that can partially take over the blood supply from the blocked vessel,” Floor explains. “These collaterals must already be present before the stroke; that’s a matter of predisposition and medical history,” she states. Collaterals can buy extra time for treatment because they continue to supply the brain tissue with some blood. The presence of collaterals was used as a selection criterion in the MR CLEAN-LATE study. Collaterals can be assessed on the standard CT scans of patients, which are performed immediately upon suspicion of a stroke. “Assessing the presence of collaterals therefore does not delay the treatment process,” Floor explains. Floor notes that this type of imaging plays an important role in the treatment of a stroke. “In fact, imaging largely determines the choices doctors must and dare to make,” she says.

“We live in an era in which there is increasing pressure on the healthcare system in the Netherlands. As a result, choices simply have to be made. That is why it is important, when considering new medical innovations, to look not only at the effect on the individual patient, but also at the ultimate impact from a societal perspective.”

For this reason, Floor investigated whether catheter treatment administered at a later time is not only effective but also cost-effective. In her analysis, Floor examined both the costs and the long-term effects of the treatment, including the long-term quality of life of patients and the healthcare costs associated with catheter treatment.  Her research showed that the treatment remains cost-effective even when administered at a later stage. As a result, this treatment method can ultimately help more patients who have suffered a stroke.

Tekst: Milou Scholten