An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulation acute ischemic stroke: outcomes with respect to age

Abstract

BackgroundThrombectomy is an efficacious treatment for acute ischemic stroke (AIS). However, relatively few studies to date have specifically examined the impact and clinical implications of age on outcomes for thrombectomy in anterior AIS.ObjectiveTo provide a snapshot of patient metrics and outcomes with respect to age following thrombectomy for anterior AIS to supplement the current body of data for predictors of clinical outcomes in a real-world setting.MethodsData were collected for 20 consecutive patients with AIS treated with thrombectomy at 15 high-volume stroke centers across North America between 2015 and 2016. Patients with anterior occlusions were dichotomized based on whether they were older or younger than 80 years. Ordinal logistic regression analyzed how clinical variables impacted disability using 90-day modified Rankin Scale (mRS) scores.ResultsAdequate revascularization (TICI ≥2B) was achieved in 92.3% of patients aged <80 years with an average 1.7±0.1 passes taken with the primary technique and in 88.0% of patients aged ≥80 years with an average 1.7±0.2 passes. Despite similar baseline characteristics, mRS scores were significantly higher in older patients postoperatively and at 90 days after intervention. Age was a significant predictor of 90-day mRS across the study population.ConclusionThis analysis affirms age is a significant determinant of 90-day mRS scores following thrombectomy for large vessel anterior AIS. Further investigation into risks faced by elderly patients during thrombectomy may provide actionable information to help refine patient selection and improve outcomes.

Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United States

“…This increase in the use of thrombectomy did not benefit patients uniformly, suggesting that the demographic, socioeconomic, and regional disparities observed in stroke care before the thrombectomy era (20-23) remain persistent today. Similar to other investigators, we also found age to be a key factor affecting mortality, especially in patients aged 80 years and older (24,25). The rate of readmission for recurrent stroke at 90 days (2.9%) was similar to that in the Multicenter Collaboration Assuming a similar recovery in the NIS cohort, an estimated 38.6% of patients in the NIS would reach a modified Rankin Scale score of 0-2 at 3 months, which is lower than the 46% who achieved this outcome in the HERMES meta-analysis, albeit equivalent to or better than the 32.6% in the Multicenter Collaboration for Endovascular Treatment of Acute Ischemic Stroke in the Netherlands trial (5) (the least selective trial, with the lowest proportion of patients reaching a modified Rankin scale score of 0-2 at 3 months).…”

“…However, patients who underwent thrombectomy in the NIS were older, had a higher proportion aged 80 years or older, and had more comorbidities than those who underwent thrombectomy in HERMES. Previous studies have shown higher mortality and less favorable outcomes after thrombectomy in patients aged 80 years or older (24,25) and in patients with worse premorbid disability (32). However, fewer ICA strokes in the NIS thrombectomy cohort would have favored better outcomes in this group.…”

Outcomes in Endovascular Therapy for Basilar Artery Occlusion: Intracranial Atherosclerotic Disease vs. Embolism

“…We identified a significant association between embolism and functional independence among patients with BAO that were 60 years old and younger. Perhaps, this is because younger stroke patients have a relatively better prognosis post-EVT [25], which further increases the difference in prognosis among patients with different pathological mechanisms of stroke. A retrospective study also revealed that younger patients with embolic BAO were more likely to benefit from thrombolysis [26].…”

“…The median GCS, NIHSS, and pc-ASPECTS scores were 8 (IQR, 5-12), 23 (IQR, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], and 8 (IQR, 7-10), respectively. A total of thirty-four patients (20.4%) were administered intravenous alteplase prior to EVT.…”

Tracking elemental changes in an ischemic stroke model with X-ray fluorescence imaging

“…During ischemic stroke, a volume of brain tissue is immediately starved of oxygen and nutrients supplied from the blood. Thrombolytics can be used acutely to treat large vessel occlusions, but have the potential to cause hemorrhagic transformation, while for patients with large vessel occlusion of the cerebral vessels, such as the middle cerebral artery, endovascular mechanical thrombectomy can be a highly efficacious alternative 2 . The most important patient characteristic determining post-stroke outcome is the amount of penumbra that can be salvaged by restoring normal blood flow 3 – 5 .…”