Neurology
-
Though rarely considered in the clinical decision algorithm, issues of cost-effectiveness assume critical importance for the sustainability of a widely used therapy that entails considerable cost and has unproven benefit. Although current data are limited, we review the studies that have demonstrated via modeling that endovascular stroke treatment may generate significant future economic benefits, even if these treatments have a high price and result in relatively small initial reductions in disability. We highlight important considerations that, on the basis of the logistics and protocols of current neuroendovascular practices, should be included in future cost-effectiveness analyses of endovascular therapy for acute ischemic stroke.
-
Review
Developing practice recommendations for endovascular revascularization for acute ischemic stroke.
Guidelines have been established for the management of acute ischemic stroke; however, specific recommendations for endovascular revascularization therapy are lacking. Burgeoning investigation of endovascular revascularization therapies for acute ischemic stroke, rapid device development, and a diverse training background of the providers performing the procedures underscore the need for practice recommendations. ⋯ This document was developed to review current clinical efficacy of pharmacologic and mechanical revascularization therapy, selection criteria, periprocedure management, and endovascular time metrics and to highlight current practice patterns. It therefore provides an outline for the future development of multisociety guidelines and recommendations to improve patient selection, procedural management, and organizational strategies for revascularization therapies in acute ischemic stroke.
-
Multicenter Study
Brain MRI markers and dropout in a longitudinal study of cognitive aging: the Three-City Dijon Study.
Longitudinal studies of dementia rely on the assumption that individuals who drop out are comparable to those who remain in the study, adjusting for measured covariates. Existing methods to handle dropouts account for differences based on past health and cognitive measures. We assess whether such adjustments fully account for differences in future dementia risk. ⋯ Higher future dementia risk, indicated by worse past brain MRI findings, predicted future study dropout. Adjustment for selective attrition, based on MRI markers when available, may help reduce bias in estimates of dementia incidence and improve research on dementia risk factors. MRI findings may also help prospectively identify cohort members at elevated risk of attrition.