Endovascular Treatment for Acute Ischemic Stroke Patients over 80 Years of Age

Hwang, Kihwan; Hwang, Gyojun; Kwon, O-Ki; Kim, Chang Hyeun; Ban, Seung Pil; Han, Moon‐Ku; Bae, Hee‐Joon; Kim, Beom Joon; Bang, Jae Seung; Oh, Chang Wan; Lee, Boram; Jeong, Eun-A

doi:10.7461/jcen.2015.17.3.173

Cited by 16 publications

(7 citation statements)

References 42 publications

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“…However, many elderly patients still do not achieve good outcomes despite successful revascularization. The reported rate of futile recanalization among elderly patients has been 45-54% [23,27], and in our study it was 50.5%. This is likely multifactorial, and possibly related to decreased neuronal plasticity with age and to diminished capacity to recruit the collateral circulation, with subsequently larger infarct volumes [18,28,29].…”

Section: Discussionmentioning

confidence: 55%

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

et al. 2018

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Background: The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. Methods: Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. Results: Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, p = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, p = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, p = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (p < 0.001 and p = 0.009, respectively). Conclusion: Advanced age, baseline disability, and delayed treatment are associated with suboptimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

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Section: Discussionmentioning

confidence: 55%

Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

et al. 2018

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“…In the 5 randomized controlled trials the mortality rate was 15.3% [29] -rates comparable to the younger patients in our study. Previous studies on EVT in elderly patients report mortality rates anywhere between 12.5 and 44% [13,[25][26][27]. The higher mortality rates in the elderly may be explained by a higher pre-stroke morbidity, higher rates of post stroke complications, and decreased neuronal capacity.…”

Section: Discussionmentioning

confidence: 94%

“…Previous studies have shown an overall favorable outcome rate in 19-35.7% of patients aged > 80 [13,[25][26][27] and a recent study showed good clinical outcome in 51.6% of these cases [28]. A prerequisite for good clinical outcome is successful recanalization.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

et al. 2019

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Objectives: Endovascular treatment (EVT) has emerged as the gold standard therapy for stroke due to large vessel occlusion (LVO). There is however limited evidence to suggest that similar efficacy can be expected in elderly patients. We aimed to assess the efficacy and safety of EVT in elderly patients (aged > 80), comparing outcomes to younger patients (aged < 80). Material and Methods: A total of 195 patients with LVO stroke treated with EVT were included and dichotomized by age. We compared neurological improvement, clinical 90 day outcome, technical recanalization rates, procedure-related complications, and mortality in between the groups. Results: Both groups showed equally marked neurological improvement. A favorable outcome modified Rankin Scale (mRS < 2) was seen in 28% of the elderly patients compared to 46% of the younger patients (p = 0.01). mRS 0–3 was seen in 46% of the elderly patients and 58% of the younger patients (p = 0.09). The rates of successful technical recanalization did not differ between the groups and there were no differences in procedural complication rates or incidence of symptomatic intracranial bleeding. Three-month mortality rates were however higher in the elderly group. Conclusions: EVT in the elderly resulted in equally notable neurological improvement as compared to younger patients. Although the elderly had a higher mortality rate and fewer favorable clinical outcomes at 3 month follow-up, a strict upper age limit for EVT seems unjustified.

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“…21,22 In contrast, a recently published report found that endovascular therapy improved the outcome and reduced the risk of hospital-acquired infections in patients Ն80 years with acute stroke. 23 In most of the recent large randomized trials, there was no upper age limit, 7,8,24 and the oldest patient in the MR CLEAN trial was 96 years old. 7 A subgroup analysis of the MR CLEAN trial showed a treatment effect in all subgroups, including the one based on age.…”

Section: Discussionmentioning

confidence: 99%