Endovascular Treatment for Acute Ischemic Stroke in Octogenarians Compared with Younger Patients: A Meta-Analysis

Duffis, E. Jesús; He, Wenzhuan; Prestigiacomo, Charles J.; Gandhi, Chirag D.

doi:10.1111/ijs.12098

Cited by 46 publications

(33 citation statements)

References 19 publications

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“…Because endovascular approaches to acute ischemic stroke treatment are increasingly offered to older patients, despite a higher risk of poor outcome compared with younger patients, 12 appropriate patient selection beyond procedural aspects represents an important goal in this population.…”

Section: Discussionmentioning

confidence: 99%

“…In summary, with a projected increase in the occurrence of strokes, especially among the elderly, 9-11 clinicians will be increasingly 12 faced with the issue of appropriately selecting elderly patients with severe strokes for EST. Our data provide preliminary evidence that patients with severe pre-existing leukoaraiosis are at high risk for a poor functional outcome after EST.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Given the expected tripling of the number of persons aged 60 or older in developed nations by 2050 9 and the increasing prevalence of stroke with advancing age, 10,11 it is expected that an increasing number of patients with pre-existing leukoaraiosis will be treated with EST. 12 Accordingly, it is important to understand the potential contribution of leukoaraiosis to functional outcome after EST.…”

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confidence: 99%

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Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Zhang¹,

Puri²,

Khan

et al. 2014

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Zhang¹,

Puri²,

Khan

et al. 2014

AJNR Am J Neuroradiol

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“…16 Medical comorbidities, baseline disabilities, stroke complications, or earlier withdrawal of care could potentially decrease the significance of POST score as an independent predictor of good outcome in these patients. Performance of the POST score in the octogenarians in the UPMC validation cohort was compared with the GMH derivation cohort ( Figure 4A).…”

Section: Post Score In Octogenariansmentioning

confidence: 99%

Pittsburgh Outcomes After Stroke Thrombectomy Score Predicts Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions

Rangaraju

Liggins

Aghaebrahim

et al. 2014

Stroke

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A cute large vessel occlusion strokes (LVOS) account for 25% to 40% of all acute ischemic strokes, resulting in significant morbidity and mortality. Data from a natural history study of patients with LVOS with moderate-severe deficits (National Institutes of Health Stroke Scale [NIHSS] ≥10) also suggested low rates of good outcome (modified Rankin Score [mRS], 0-2) in internal carotid artery (14%) and M1 middle cerebral artery (23%) occlusions.1 Proximal occlusions are also less likely to recanalize with intravenous thrombolysis, and clinical trials are underway to determine whether endovascular therapy improves clinical outcome. 2,3 In anterior circulation LVOS patients, the final infarct volume (FIV) is a strong and independent predictor of clinical outcome. 4,5After endovascular therapy for LVOS, aggressive medical measures including continuation of life support and surgical therapies (hemicraniectomy, gastrostomy, and tracheostomy) are frequently considered. The decision to pursue aggressive treatment versus de-escalation of care often depends on an estimation of the chance of long-term functional independence. Stroke and critical care physicians are the ones guiding families in this complex decision-making process. Results from the Clinician Judgment vs Risk Score to Predict Stroke Outcomes Background and Purpose-Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy. Methods-In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0-2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111). Results-In the derivation cohort, independent predictors (P<0.1) of good outcome included 24-to 72-hour final infarct volume (in cm 3 , P<0.001), age (years, P<0.001), and parenchymal hematoma types 1 and 2 (H, P=0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score <60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the isch...

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“…Several studies show increasing age correlation with unfavourable outcomes [21,26,27] with lower rates of recanalization [19] and higher mortality and haemorrhage [28] …”

Section: Discussionmentioning

confidence: 99%

Differences in Factors Predicting Outcome and Mortality after Mechanical Thrombectomy for Acute Large Vessel Stroke Between Patients over and Under 70 Years of Age: A Five Year Retrospective Study

Nayak¹

2015

SOJN

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Endovascular Treatment for Acute Ischemic Stroke in Octogenarians Compared with Younger Patients: A Meta-Analysis

Cited by 46 publications

References 19 publications

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Leukoaraiosis Predicts a Poor 90-Day Outcome after Endovascular Stroke Therapy

Pittsburgh Outcomes After Stroke Thrombectomy Score Predicts Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions

Differences in Factors Predicting Outcome and Mortality after Mechanical Thrombectomy for Acute Large Vessel Stroke Between Patients over and Under 70 Years of Age: A Five Year Retrospective Study

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