Angioplasty associated with triple costs and unclear safety and efficacy

Angioplasty associated with triple costs and unclear safety and efficacy
American Stroke Association Meeting Report: Abstract LB12



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Study Highlights:

•A review of health records demonstrated that angioplasty and stenting of blood vessels within the skull for stroke victims is most often done in urban teaching hospitals and is associated with higher hospital charges. Yet, its efficacy and safety remains unclear.
•The study is the first large-scale outcomes study of angioplasty with or without stenting in the blood vessels to the brain of stroke patients.


LOS ANGELES, Feb. 11, 2011 – Angioplasty and stenting of the blood vessels within the skull (intra-cranial vessels) that supply blood to the brain was predominantly performed at urban teaching hospitals and was associated with nearly triple the cost compared to usual care. However, data on the efficacy and safety of these procedures remains uncertain according to late-breaking science reported at the American Stroke Association’s International Stroke Conference 2011.

Angioplasty and stenting of the carotid arteries in the neck was excluded from this review.

Authors of the study Intracranial Angioplasty and/or Stent Placement in General Practice analyzed health records from more than 370,000 patients treated from 2005 to 2007 at 1,000 hospitals that participate in the National Inpatient Survey, the largest U.S. all-payer inpatient care database. It is the first large-scale national review of intra-cranial angioplasty and stenting, including outcomes data.

“Our findings show these procedures still carry high immediate complication rates and evidence of their efficacy is sketchy and ambiguous” said Yousef Mohammad, M.D., M.Sc., the study’s lead author, and an associate professor of neurology and director of the Stroke Fellowship Program at Rush University in Chicago.

“The three-fold higher hospitalization charges highlight the need for cost-effective application of these procedures,” he said. The study’s primary endpoints were the rate and distribution of intracranial angioplasty in U.S. hospitals. Researchers found:

•About 80 percent of angioplasty or angioplasty-stent procedures are performed at urban teaching hospitals – possibly due to the need for highly specialized physicians and care units.
•158 patients (average age 64, 46 percent female) underwent intracranial angioplasty, in which a balloon-tipped catheter is threaded into the brain’s circulation and inflated to reopen a blocked vessel.
•169 patients (average age 62, 50 percent female) had angioplasty plus stenting – placement of a tiny mesh tube in the artery to help keep the vessel open.

“In addition, we found that the in-hospital mortality in the patients who had these procedures was 16 percent for angioplasty and 4 percent for angioplasty plus stent, which was much higher than the 3.3 percent mortality rate for stroke patients who did not undergo either procedure, even though that group tended to be older,” he said.

The increased in-patient mortality rate is beyond what is expected in patients presenting with symptomatic intracranial disease without this procedure, Mohammad said.

Moreover, researchers noted that in-hospital charges in patients having these procedures was approximately triple that of patients who did not, costing an average of $89,175 in angioplasty patients and $61,050 in angioplasty-plus-stent patients compared to $24,303 for patients who had neither procedure, he added. Researchers note that a significant proportion of the costs is attributed to the procedure itself.

Potential limitations of the study include that the data was gathered from a voluntary registry rather than from a blinded, prospective, randomized trial and was limited to evaluation of short-term data about how patients fared during the time immediately following the procedure, he said.

The evolution of intracranial angioplasty and/or stent placement appears similar to the early days of other new procedures, such as the early days of angioplasty in the coronary arteries supplying the heart muscle, which is now a common procedure, Mohammad said.

However, he suggests doctors await the results of an ongoing study (SAMMPRIS) that randomize patients to angioplasty with or without stenting versus usual care before recommending this procedure to their patients. In his opinion, the SAMMPRIS trial will determine if the procedure is cost effective.

Co-authors are: Saqib Chaudry, M.D.; Gabriela Vazquez, Ph.D.; Fareed K. Suri, M.D.; and Adnan I. Qureshi, M.D. Author disclosures are on the abstract. There was no outside funding.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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NR11-1024 (ISC 2011/Mohammad)

(Note: Actual presentation time is 12:18 p.m. PT., Friday, Feb. 11, 2011)

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Angioplasty associated with triple costs and unclear safety and efficacy