Cardiologists partial to the use of endovascular thrombectomy for ischemic stroke patients will be hard hit by a possible halting of insurance payment for the clot-grabbing devices.
Insurance companies in the United States are considering the withdrawal of reimbursement for thrombectomy devices (catheters designed to remove blood clots) for all ischemic stroke patients, according to Joseph P. Broderick, MD, and Thomas A. Tomsick, MD, of the Interventional Management of Stroke (IMS) III Executive Committee.
The discussion comes two months after a
study by IMS III investigators found that compared to intravenous thrombolytic therapy (injection of clot busting proteins) alone, the use of thrombectomy devices (i.e. catheters) following thrombolytic therapy did not improve outcomes for patients with acute ischemic stroke.
Stroke is the No. 4 cause of death and a leading cause of disability in the United States, according to the American Heart Association. When a stroke occurs, a blood vessel is either blocked by a clot or bursts, preventing the vessel from delivering oxygen and nutrients to the brain.
Hotly debated is the potential pay denial for all thrombectomy devices even when the patient is not eligible at admission for the tissue plasminogen activator (t-PA) injectable thrombolytic treatment.
An editorial published in
Stroke, a monthly journal published by the American Heart Association, gives an example of a 60-year-old woman presenting with a severe stroke and ineligible for t-PA. Per the current insurance discussions, the patient would either not receive the thrombectomy device procedure or be forced to pay for the procedure herself. And this is regardless of her outcome.
“We strongly recommend that insurance companies continue to reimburse hospitals for t-PA–ineligible patients treated with an endovascular reperfusion therapy within the 4.5-hour time window from stroke onset, whether or not they are part of a randomized treatment trial,” read the Stroke editorial written Broderick and Tomsick.