Higher Rates of Mortality but Not Morbidity Follow Intracranial Mechanical Thrombectomy in the Elderly

Abstract

BACKGROUND AND PURPOSE:Mechanical thrombectomy is a promising means of recanalizing acute cerebrovascular occlusions in certain situations. We sought to determine if increasing age adversely affects prognosis.

Influence of Age on Clinical and Revascularization Outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry

“…3,5,[11][12][13][14][15] Although patients >80 years of age demonstrated lower rates of good clinical outcome at 90 days, elderly patients achieved similar revascularization rates (TICI≥2b; 69.2% versus 73.1%; P=0.5), but at a slower duration (93.1±114.5 versus 71.7±89.5 minutes; P=0.08) than younger patients. Revascularization rates in several studies examining ET in the elderly ranged from 62% to 87.9%, [3][4][5]11,12,16 which are comparable with the findings from the current study. All but one series found no correlation between age >80 years and the likelihood of revascularization.…”

“…For the purpose of this substudy, the NASA cohort was dichotomized into 2 age groups based on previous studies [3][4][5] : patients ≤80 years of age and those >80 years old. Thrombolysis in Myocardial Ischemia (TIMI) and Treatment in Cerebral Ischemia (TICI) revascularization grades were defined according to the SWIFT and TREVO 2 trial definitions, respectively.…”

“…[3][4][5] However, these initial studies were limited by their small patient size and inclusion of first-generation retrieval devices. Because the elderly population, which carries a higher incidence of stroke, is expected to nearly double over the next several decades, 6,7 it is critical to investigate the benefit of newer treatments and to understand potential characteristics within this population, which may influence clinical outcome following endovascular therapy (ET).…”

Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

“…In the field of the endovascular therapy prior to stent-retrievers (Table 5), Kim et al [3] obtained a recanalization rate of 68 % by using intraarterial thrombolysis with urokinase or tPA, with a mortality of 43 % and a tendency to higher mortality rates and lower functional outcomes in the octogenarians group compared with younger patients. Loh et al [4] reported recanalization rates of 81 % and a mortality of 48 % in acute stroke octogenarians treated with the Merci thrombectomy device. Mono et al [18] treated 53 patients with intra-arterial thrombolytics plus optional mechanical therapy with aspiration, clot retrieval, angioplasty, and/or stenting, with NIHSS National Institute of Health Stroke Scale, mRS modified Rankin Scale, SH symptomatic haemorrhage, SP stroke progression, SC systemic complication, TICI thrombolysis in cerebral infarction, VR vessel rupture ICA internal carotid artery, mRS modified Rankin Scale similar results, and Chandra et al [19] reviewed 34 patients treated with the Merci retriever or the Penumbra aspiration device, finding a mortality of 58 % and mRS C 3 at 3 months of 97 %.…”

“…This tendency might be partly explained by the results of previous studies, which show that the mortality rate after different treatments (intravenous thrombolysis, intra-arterial thrombolysis, mechanical thrombectomy with classic retrievers) is higher in octogenarians than in younger patients, conveying increased age a higher rate of stroke-related death [2][3][4]. In the past years, stent-retrievers seem to have opened a new window in the field of mechanical thrombectomy, achieving better angiographic and clinical outcomes than classic retrievers [5,6], but their effect and security in the older patients have scarcely been reported [7].…”