***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Endovascular therapy in addition to st and ard care ( EVT+SC ) has been demonstrated to be more effective than SC in acute ischemic large vessel occlusion stroke . Our aim was to determine the cost-effectiveness of EVT+SC depending on patients ’ initial National Institutes of Health Stroke Scale ( NIHSS ) score , time from symptom onset , Alberta Stroke Program Early CT Score ( ASPECTS ) , and occlusion location . Methods — A decision model based on Markov simulations estimated lifetime costs and quality -adjusted life years ( QALYs ) associated with both strategies applied in a US setting . Model input parameters were obtained from the literature , including recently pooled outcome data of 5 r and omized controlled trials ( ESCAPE [ Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke ] , EXTEND-IA [ Extending the Time for Thrombolysis in Emergency Neurological Deficits – Intra-Arterial ] , MR CLEAN [ Multicenter R and omized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherl and s ] , REVASCAT [ R and omized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within 8 Hours of Symptom Onset ] , and SWIFT PRIME [ Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment ] ) . Probabilistic sensitivity analysis was performed to estimate uncertainty of the model results . Net monetary benefits , incremental costs , incremental effectiveness , and incremental cost-effectiveness ratios were derived from the probabilistic sensitivity analysis . The willingness-to-pay was set to $ 50 000/QALY . Results — Overall , EVT+SC  was cost-effective compared with SC ( incremental cost : $ 4938 , incremental effectiveness : 1.59 QALYs , and incremental cost-effectiveness ratio : $ 3110/QALY ) in 100 % of simulations . In all patient subgroups , EVT+SC led to gained QALYs ( range : 0.47–2.12 ) , and mean incremental cost-effectiveness ratios were considered cost-effective . However , subgroups with ASPECTS ⩽5 or with M2 occlusions showed considerably higher incremental cost-effectiveness ratios ( $ 14 273/QALY and $ 28 812/QALY , respectively ) and only reached suboptimal acceptability in the probabilistic sensitivity analysis ( 75.5 % and 59.4 % , respectively ) . All other subgroups had acceptability rates of 90 % to 100 % . Conclusions — EVT+SC is cost-effective in most subgroups . In patients with ASPECTS ⩽5 or with M2 occlusions , cost-effectiveness remains uncertain based on current data Background and Purpose — Recently , 5 r and omized controlled trials demonstrated the benefit of endovascular therapy compared with intravenous tissue-type plasminogen activator in acute stroke . Economic evidence evaluating stent retrievers is limited . We compared the cost-effectiveness of intravenous tissue-type plasminogen activator alone versus mechanical thrombectomy and intravenous tissue-type plasminogen activator as a bridging therapy in eligible patients in the UK National Health Service . Methods — A model-based cost-utility analysis was performed using a lifetime horizon . A Markov model was constructed and populated with probabilities , outcomes , and cost data from published sources , including 1-way and probabilistic sensitivity analysis . Results — Mechanical thrombectomy was more expensive than intravenous tissue-type plasminogen activator , but it improved quality -adjusted life expectancy . The incremental cost per ( quality -adjusted life year ) gained of mechanical thrombectomy over a 20 year period was $ 11 651 ( £ 7061 ) . The probabilistic sensitivity analysis demonstrated that thrombectomy had a 100 % probability of being cost-effective at the minimum willingness to pay for a quality -adjusted life year commonly used in United Kingdom . Conclusions — Although the upfront costs of thrombectomy are high , the potential quality -adjusted life year gains mean this intervention is cost-effective . This is an important factor for consideration in deciding whether to commission this intervention Background and Purpose — Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator ( SST+tPA )  compared with tPA . Previous studies suggested that this strategy may be cost-effective , but models were derived from pooled data and older assumptions . Methods — In this prospect i ve economic sub study conducted alongside the SWIFT-PRIME trial ( Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke ) , in-trial costs were measured for patients using detailed medical re source utilization and hospital billing data . Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension question naire . Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors . Results — Index hospitalization costs were $ 17 183 per patient higher for SST+tPA than for tPA ( $ 45 761 versus $ 28 578 ; P<0.001 ) , driven by initial procedure costs . Between discharge and 90 days , costs were $ 4904 per patient lower for SST+tPA than for tPA ( $ 11 270 versus $ 16 174 ; P=0.014 ) ; total 90-day costs remained higher with SST+tPA ( $ 57 031 versus $ 44 752 ; P<0.001 ) . Higher utility values for SST+tPA led to higher in-trial quality -adjusted life years ( 0.131 versus 0.105 ; P=0.005 ) . In lifetime projections , SST+tPA was associated with substantial gains in quality -adjusted life years ( 6.79 versus 5.05 ) , cost savings of $ 23 203 per patient and was economically dominant when compared with tPA in 90 % of bootstrap replicates . Conclusions — Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial , SST increased initial treatment costs , but was projected to improve quality -adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01657461 Background and Purpose — The benefit of mechanical thrombectomy added to intravenous thrombolysis ( IVT ) in patients with acute ischemic stroke has been largely demonstrated . However , evidence of the economic incentive of this strategy is still limited , especially in the context of a r and omized controlled trial . We aim ed to analyze whether mechanical thrombectomy combined with IVT ( IVMT ) is cost-effective when compared with IVT alone . Methods — Individual-level cost and outcome data were collected in the THRACE r and omized controlled trial ( Thrombectomie des Artères Cerébrales ) including patients with acute ischemic stroke . Patients were assigned to receive IVT or IVMT . The primary outcomes were modified Rankin Scale score of functional independence at 90 days ( score 0–2 ) and the EuroQol-5D quality -of-life score at 1 year . Results — Treating acute ischemic stroke with IVMT ( n=200 ) versus IVT ( n=202 ) increased the rate of functional independence by 10.9 % ( 53.0 % versus 42.1 % ; P=0.028 ) , at an increased cost of $ 2116 ( & OV0556;1909 ) , with no significant difference in mortality ( 12 % versus 13 % ; P=0.70 ) or symptomatic intracranial hemorrhage ( 2 % versus 2 % ; P=0.71 ) . The cost per one averted case of disability was estimated at $ 19 379 ( & OV0556;17 480 ) . The incremental cost per one quality -adjusted life year gained was $ 14 881 ( & OV0556;13 423 ) . On sensitivity analysis , the probability of cost-effectiveness with IVMT was 84.1 % in terms of cases of averted disability and 92.2 % in terms of quality -adjusted life years . Conclusions — Based on r and omized trial data , this study demonstrates that IVMT used to treat acute ischemic stroke is cost-effective when compared with IVT alone . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01062698 Objective : To evaluate the cost-effectiveness of adding endovascular thrombectomy to st and ard care in patients with acute ischemic stroke . Methods : The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model . Primary outcomes from ESCAPE , Extending the Time for Thrombolysis in Emergency Neurological Deficits – Intra-Arterial ( EXTEND-IA ) , Multicenter R and omized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherl and s ( MR CLEAN ) , Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours ( REVASCAT ) , and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke ( SWIFT PRIME ) along with data from published studies and registries were used in this analysis . We used a health care payer perspective and a lifelong time horizon to estimate costs and effects . Results : The model showed that adding thrombectomy with stent retrievers to guideline -based care ( including IV thrombolysis ) result ed in a gain of 0.40 life-years and 0.99 quality -adjusted life-years along with a cost savings of approximately $ 221 per patient . The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions . Conclusions : Adding endovascular treatment to st and ard care result ed in substantial clinical benefits at low costs . The results were consistent throughout irrespective of whether data from ESCAPE , EXTEND-IA , MR CLEAN , REVASCAT , or SWIFT PRIME were used in this model Background and Purpose — Long-term outcome information after transient ischemic attack ( TIA ) and stroke is required to help plan and allocate care services . We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population -based study . Methods — Patients from a UK population -based cohort study ( Oxford Vascular Study ) were recruited from 2002 to 2007 and followed up to 2012 . Patients were followed up at 1 , 6 , 12 , 24 , and 60 months postevent and assessed using the modified Rankin scale . A multivariate regression analysis was performed to assess the predictors of disability postevent . Results — A total of 748 index stroke and 440 TIA cases were studied . For patients with TIA , disability levels increased from 14 % ( 63 of 440 ) premorbidly to 23 % ( 60 of 256 ) at 5 years ( P=0.002 ) , with occurrence of subsequent stroke being a major predictor of disability . For stroke survivors , the proportion disabled ( modified Rankin scale > 2 ) increased from 21 % ( 154 of 748 ) premorbidly to 43 % ( 273 of 634 ) at 1 month ( P<0.001 ) , with 39 % ( 132 of 339 ) of survivors disabled 5 years after stroke . Five years postevent , 70 % ( 483 of 690 ) of patients with stroke and 48 % ( 179 of 375 ) of patients with TIA were either dead or disabled . The 5-year risk of care home institutionalization was 11 % after TIA and 19 % after stroke . The average 5-year cost per institutionalized patient was $ 99 831 ( SD , 67 020 ) for TIA and $ 125 359 ( SD , 91 121 ) for stroke . Conclusions — Our results show that 70 % of patients with stroke are either dead or disabled 5 years after the event . Thus , there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization Purpose — The aim of this guideline is to provide a focused up date of the current recommendations for the  endovascular  treatment of  acute ischemic stroke . When there is overlap , the recommendations made here supersede those of previous guidelines . Methods — This focused up date analyzes results from 8 r and omized , clinical trials of endovascular treatment and other relevant data published since 2013 . It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations . Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council ’s Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee . Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process . Recommend 
    Output:
    
Conclusion This review shows that SRT added/not added to IV t-PA is likely to be cost-effective or even dominant , which is consistent with the opinion from several Health Technology Assessment bodies recommending SRT .