Mechanical thrombectomy devices for acute ischaemic stroke

The technologies described in this briefing are 21 mechanical thrombectomy devices of 2 types: stent retrievers and aspiration catheters. They are used to remove blood clots from a main cerebral artery to restore blood flow after acute ischaemic stroke.

The innovative aspects are that the devices restore blood flow in people who are not able to have pharmacological treatment. They can also be used in people for whom pharmacological treatment has not worked effectively.

The intended place in therapy would be in patients with confirmed acute ischaemic stroke caused by a blockage in 1 or more large artery in the brain.

The main points from the evidence summarised in this briefing are from 8 clinical studies (1 systematic review and 7 randomised controlled trials) including a total of 2,718 adults in secondary and tertiary care. Overall, the studies show that mechanical thrombectomy devices used with thrombolysis are more effective than thrombolysis alone in patients with acute ischaemic stroke. Overall, the evidence base is greater for stent retrievers.

Key uncertainties around the evidence or technology are that there is little comparative evidence between the devices. The evidence that does exist does not take into account underlying differences in patient populations or care pathways, which may be different to the NHS.

The cost of mechanical thrombectomy devices ranges from £550 to £1,349 for aspiration catheters and £1,500 to £5,000 for stent retrievers per unit (excluding VAT). Current evidence suggests the resource impact in the UK is higher because of the cost of the mechanical thrombectomy procedure. Twelve cost-effectiveness studies were also identified, including 2 from a UK payer perspective. The resource impact may be lower if effective treatment results in a reduction in long-term care.