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

Abstract

Background and Purpose-The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry. Methods-The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into ≤80 and >80 years of age. Results-Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were ≤80 years and 78 were >80 years of age. Mean age in the ≤80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score ≤2 versus 45.4% ≤80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and ≤80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality. Conclusion-Greater

TICI and Age: What's the Score?

“…These mortality rates were lower for both age groups than those reported in previous studies, with the North American Solitaire Stent Retriever Acute Stroke (NASA) registry reporting 27.3% 90-day mortality in the younger group and 43.9% in the older group. 12 Most interesting, Engelter et al 9 in their analysis of IV thrombolysis and Mono et al 10 in their analysis of intra-arterial thrombolysis reported lower rates of 90-day mortality compared with the NASA registry, with 12% and 22% mortality for younger cohorts, respectively, and 32% and 40% mortality in the older cohorts. The Engelter and Mono studies reviewed results using treatment methods with lower recanalization rates than stent retrievers, and the NASA registry had an older patient population.…”

“…Additionally, in our study, there was no difference in intracranial hemorrhage rates of all types in the younger age group (19% versus 14%, P ϭ .410); moreover, hemorrhage did not have a significant impact on differences in clinical outcome or mortality rates between the 2 groups and is in keeping with previously published results. 12 Singer et al 22 demonstrated the highest rates of good clinical outcome (mRS Յ2) in the youngest quartile (60%) and the lowest in the oldest quartile (17%). They then dichotomized the entire patient cohort into good and poor clinical outcomes and determined the proportion of patients within each group in whom successful reperfusion was achieved.…”

“…[6][7][8] However, it has been reported in multiple studies that despite similar rates of recanalization, the elderly have higher mortality rates and poorer outcomes than younger patients following intra-arterial treatment. 7,[9][10][11][12][13] These studies were mostly retrospective, single-center series or used older generation devices with suboptimal reperfusion rates. 7,[9][10][11][12][13] Recent clinical studies demonstrating the value of mechanical thrombectomy for acute ischemic stroke (AIS) did not include a significant number of elderly patients.…”

“…7,[9][10][11][12][13] These studies were mostly retrospective, single-center series or used older generation devices with suboptimal reperfusion rates. 7,[9][10][11][12][13] Recent clinical studies demonstrating the value of mechanical thrombectomy for acute ischemic stroke (AIS) did not include a significant number of elderly patients. [14][15][16][17] We performed a post hoc analysis of 2 prospective core lab-reviewed studies assessing mechanical thrombectomy by using new-generation devices (stent retrievers) for AIS to determine whether the benefit of reperfusion was constant across age groups, including the older population.…”

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

“…2014). A short delay to initiation of treatment with IV tPA enhances the odds for a good outcome in acute stroke patients (Emberson et al.…”