Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke - Research Protocols | AHRQ Effective Health Care Program

AHRQ’s Effective Health Care Program Technical Brief on Stroke Care Is Available

AHRQ released a new technical brief highlighting a significant research gap related to stroke care. The brief finds that there is limited high quality research regarding the use of neurothrombectomy devices — an emerging technology — for the treatment of acute ischemic stroke. A significant unmet need exists for randomized controlled trials to determine the optimal device(s) to use, and the patient populations most likely to benefit from their use. Advances in this technology may ultimately change the way that strokes are treated, but at this point, the specific population that is most likely to benefit from these devices is still under investigation. The brief, Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke, was prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center and published in the January 18 issue of Annals of Internal Medicine.


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Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke - Research Protocols | AHRQ Effective Health Care Program


Neurothrombectomy Devices for Treatment of Acute Ischemic Stroke


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http://effectivehealthcare.ahrq.gov/ehc/products/161/400/Neurothrombectomy%20Protocol%20%282-17-2010%29%20FINAL.pdf

Table of Contents

* Background and Objectives for the Technical Brief
* The Key Questions
* Analytic Framework
* Methods
* References
* Definition of Terms
* Summary of Protocol Amendments
* Appendix 1
* Appendix 2

Background and Objectives for the Technical Brief
Definition and Prevalence of Ischemic Stroke

Stroke is the third leading cause of death following diseases of the heart and cancer.1,2 A majority of strokes are classified as ischemic in nature (87 percent), with intracerebral hemorrhage (10 percent) and subarachnoid hemorrhage stroke (3 percent) accounting for the rest.2 Every year in the United States, approximately 795,000 people develop a new or recurrent stroke, with 610,000 first attacks and 185,000 recurrent attacks.2 Stroke occurs more commonly in females than males, especially at older ages.3 Blacks have a two-fold higher risk of first-ever stroke than Caucasians, with age-adjusted incidences of 6.6 per 1000 in black men as compared with 3.6 in Caucasian men.3 In 2006, 43.6 deaths occurred due to stroke per 100,000 people in the Unites States, averaging out to one death due to stroke every 3 to 4 minutes.2,4 In 2005, the overall mortality rate from stroke was approximately 44.7 per 100,000 for Caucasian males, 70.5 per 100,000 for black males, 44.0 per 100,000 for Caucasian females, and 60.7 per 100,000 for black females.5 Lower mortality rates were seen in Hispanic, Asian and American Indian populations as compared with Caucasian populations.2

Stroke is the leading causes of long-term disability in the United States. Thirty percent of stroke survivors require outpatient rehabilitation services6,7 and 15 to 30 percent of patients remain permanently disabled.2 Costs associated with acute stroke were estimated to approach $68.9 billion in 2009, with inpatient hospital costs accounting for 70 percent of the total cost in the first-year after stroke.2,8 Significant decreases in health-related quality of life are also seen following a stroke.2 Studies have shown that at-risk patients view the consequences of experiencing an ischemic stroke as being worse than death.9 Additionally, evidence has demonstrated the significant impact of ischemic stroke on caregiver burden and quality of life in caregivers.10-12