The use of multiple stent retrievers in emergent endovascular procedures; its predictors, associated costs and patient outcomes

Background and Purpose The average annual cost of stroke treatment is over $40 billion in USA. With recent advancement of tools used in thrombectomies, the question of whether the use of multiple costly devices in an emergent thrombectomy will lead to a better or worse outcome when compared to simpler devices remains unanswered. Materials and Methods We retrospectively analyzed 89 patients who underwent emergent stroke interventions at a community hospital from January 2018 to February 2021. Patients were grouped into Aspiration only (ASP) n = 15, 1 Stent-retriever (SR) + 1ASP n = 59, and ≥ 1SR + ≥ 1ASP n = 15, based on main devices/device combination used that affected cost. Demographic and perioperative variables were assessed by multivariate analysis to determine possible predictors and outcomes associated with multiple device use (≥ 1SR + ≥ 1ASP). Results The multiple device/SR group had the highest mean total cost of devices per procedure (~$21,104) when compared to No SR/ASP only (~$4,477) and 1SR + 1ASP (~$12,295) groups. We identified LSW to puncture time (OR = 1.001; 95% CI 1.000 to 1.003, p = 0.05), and NIHSS score (OR = 1.085; 95% CI 1.085 to 1.173, p = 0.04) as significant predictors of multiple device use. Regarding outcomes, the use of multiple SR was significantly associated with poor/incomplete recanalization rates (OR = 0.191, 95% CI 0.049 to 0.741, p = 0.017) and functional dependence mRS 4–6 (OR=-1.02; 95% CI -2.04 to -0.01, p = 0.048). Conclusions After an unsuccessful initial attempt with a single device to achieve complete revascularization in EVTs, the additional use of stent-retrievers leads to unimproved recanalization rates at an increased cost with no additional clinical benefit to the patients. This was especially seen in patients who presented in the delayed time window (> 360 min) with high NIHSS scores.