Abstract
IntroductionUnderstanding of costs associated with different mechanical thrombectomy (MT) approaches lags behind procedural efficacy and safety considerations. This study evaluates cost-effectiveness of MT using Monopoint (Route 92 Medical, San Mateo, CA) as first-line approach compared to traditional contact aspiration (CA) and stentriever/aspiration (SA).MethodsRetrospective analysis of consecutively treated ICA terminus or M1 occlusion patients across four high-volume stroke centers was conducted, categorized into Monopoint, CA, or SA groups. Direct device costs and total costs were obtained from institutional databases. Statistical analyses included mixed-effects linear regression and multivariable analysis.ResultsAmong 148 patients undergoing MT (Monopoint: 74, CA: 32, SA: 42), device costs were lowest for the Monopoint group ($7836 ± 4570) vs. CA ($10,089 ± 6078, p < 0.001) and SA ($19,069 ± 4730, p < 0.001). Total costs followed a similar pattern (Monopoint: $27,089 ± 19,899, CA: $28,883 ± 14,161, p < 0.001, SA: $63,327 ± 72,440, p < 0.001). Monopoint demonstrated a higher final expanded Thrombolysis In Cerebral Infarction (eTICI) 2C/3 reperfusion rate (85.1% vs. 62.5% for CA, 71.4% for SA, p < 0.001) and fewer passes (1.8 vs. 2.0, p = 0.001). Technique crossover occurred less often with Monopoint compared to CA (6.8% vs. 34.4%, p < 0.001), and similar to SA (7.1%, p = 0.937). Post-procedural subarachnoid hemorrhage was more common with CA (16.7%) or SA (6.3%) compared to Monopoint (1.3%, p = 0.003).ConclusionFirst-line MT with Monopoint showed lower direct and total costs compared to CA and SA. Monopoint cost-effectiveness may be driven by fewer passes, decreased adjunctive device use, higher recanalization rates, fewer complications, and less post-MT hemorrhage, highlighting potential economic benefits of an optimized MT strategy.