Health technology assessment of mechanical thrombectomy in Spain

In February 2020, the Office for Health Technology Assessment (HTA) of Basque Country OSTEBA published an HTA report for efficacy and safety of mechanical thrombectomy (MT) in the treatment of patients with ischaemic stroke beyond 6 hours after onset or with an unknown time of onset. According to the report, the use of MT, together with standard medical treatment (SMT) in such patients, is justified provided that they meet the neuroimaging selection criteria applied to the studies analyzed.

The HTA had the objective to assess the efficacy, effectiveness, and safety of treatment with MT in a certain group of patients selected using neuroimaging criteria. If there were supportive evidence, the next objective was to establish a protocol for selecting patients using neuroimaging tests that makes it possible to standardize procedures in this subgroup of stroke patients in clinical practice in the Spanish National Healthcare System and include this treatment on the list of services provided by this system.

Methodology:

The scientific review of the scientific evidence was conducted for the assessment. Four studies compared the effectiveness and safety of treatment MT+SMT with SMT alone.

Results:

1. Data from the studies indicate that patients treated with MT+SMT have better functional outcomes and are significantly more likely to be functionally independent at 90 days than those who receive SMT alone;
2. An early response to treatment is 3.8-fold more likely in the selected group of patients treated with MT+SMT who meet the eligibility criteria of the DAWN study;
3. There is no significant difference in safety between the use of MT and SMT alone;
4. A list of clinical and radiological criteria was proposed for selecting patients eligible for MT.

Conclusions:

1. The use of MT, together with SMT in patients with ischaemic stroke beyond six hours after onset or with an unknown time of onset, is justified provided that they meet the neuroimaging selection criteria applied to the studies analyzed;
2. Further research is warranted in relation to the patients for whom there is currently a paucity of scientific evidence, such as those with mild stroke (NIHSS 0-5) with large vessel occlusion treated within the first 24 hours after symptom onset, and those with anterior stroke with a large area of infarction (for example, an ASPECTS score less than 6 on non-contrast computer tomography or a core volume >70 ml), as well as those for whom there is hardly any evidence, such as those with posterior circulation stroke.

The full details in Spanish can be found here.

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