Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 80 Years or Older

Imahori, Taichiro; Tanaka, Kazuhiro; Arai, Atsushi; Shiomi, Ryoji; Fujiwara, Daigo; Mori, T.; Yokote, Akiyoshi; Matsushima, Kazushi; Matsui, Daisuke; Kobayashi, Makoto; Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

doi:10.1016/j.jstrokecerebrovasdis.2017.06.060

Cited by 47 publications

(39 citation statements)

References 11 publications

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“…One out of four patients in our sample was above the age of 80 years. It is well known, that following thrombectomy mortality rates are higher [11] and outcome is worse in elderly patients [12]. In line with this, our analysis identified a younger age as a consistent predictor of better outcome at 90 days, with an odds ratio of 0.950 reflecting a 5% decreased likelihood of a good outcome for every year of increase in age.…”

Section: Discussionsupporting

confidence: 84%

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

et al. 2020

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Background: Randomized controlled trials (RCTs) demonstrated efficacy and safety of endovascular treatment (ET) in anterior circulation large vessel occlusions (LVO). We aimed at investigating how stroke patients treated by thrombectomy in clinical practice and their outcome compare to cohorts and results of thrombectomy trials. Methods: In a prospective study, we consecutively included stroke patients treated by thrombectomy (2015-2017). Baseline characteristics, procedural and outcome data were analyzed. Outcome was assessed by modified Rankin Scale (mRS) at 90 days. Ordinal regression analysis was performed to identify predictors of outcome. Results: Thrombectomy was applied in 264 patients (median 75 years, 49.6% female). Median baseline National Institutes of Health Stroke Scale (NIHSS) was 16, 58.0% received concomitant intravenous thrombolysis, 62.1% were referred from external hospitals. Median Alberta Stroke Program Early CT Score (ASPECTS) was 7. Successful recanalization (modified Thrombolysis in Cerebral Infarction Score, mTICI 2b/3) was achieved in 72.0%. Symptomatic intracranial hemorrhage (sICH) occurred in 4.5%. Independent outcome (mRS 0-2) was achieved in 26.2%, poor outcome (mRS 5-6) in 49.2%. Only 33.5% met the stringent enrolment criteria of previous RCTs. Lower age, baseline NIHSS, pre-stroke mRS, higher ASPECTS, and successful recanalization were independent predictors of favourable outcome. Conclusions: The majority of stroke patients treated by ET in clinical practice would not have qualified for randomization in prior RCTs. Outcome in real-life patient cohorts is worse than in the highly selected cohorts from randomized trials, while rates of successful recanalization, sICH and outcome predictors are the same. Our findings support ET in broader patient populations than in the RCTs and may improve treatment decision in individual stroke patients with LVO in clinical practice.

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Section: Discussionsupporting

confidence: 84%

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

et al. 2020

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“…Potential explanations for the worse functional outcome and higher rates of mortality in elderly patients treated with MT are as follows: first, the age itself was a negative independent factor for prognosis; the neurological reserve and neuroplasticity in brain tissues were decreased with age, which could delay the recovery of patients (11,30,31); Second, elderly patients are usually accompanied by higher rates of in-hospital complications, such as intracerebral hemorrhage and other diseases in old age (14,16,19,32). Finally, successful recanalization was an influential factor for achieving favorable function outcome, particularly in elderly patients (21). In this meta-analysis, elderly patients had lower rates of successful recanalization in comparison with younger patients; one possible reason is that elderly patients usually have increased vessel tortuosity, which may decrease the effectiveness of thrombectomy device.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 1,810 relevant studies were initially identified through literature retrieval, and 16 studies were finally included in this meta-analysis after screening (12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). A flow diagram of the detailed search process was present in Supplemental Figure 1.…”

Section: Literature Search Study Characteristics and Quality Assessmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis

Zhao

Ping

et al. 2020

Front. Neurol.

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Background and purpose: Multiple randomized trials have confirmed that mechanical thrombectomy (MT) is an effective treatment method for patients with acute ischemic stroke (AIS). However, evidence on the safety and efficacy of MT in elderly patients compared with younger patients is controversial. This meta-analysis is aimed to systematically compare the outcomes of elderly patients and younger patients after MT for AIS.Methods: A systematic literature search was conducted through the PubMed, EMBASE, and Cochrane Library database. The primary outcomes were favorable functional outcome at 90 days and mortality. The secondary outcomes were symptomatic intracerebral hemorrhage (sICH) and successful recanalization rate. Odds ratios (ORs) were estimated using a random effects model. Results: Sixteen studies published between 2014 and 2019 were included in this meta-analysis totally involving 3,954 patients. The pooled results showed that patients aged ≥80 years had worse functional outcome (OR = 0.40; 95% CI, 0.32-0.50; P < 0.001) and higher rates of mortality (OR = 2.26; 95% CI, 1.73-2.95; P < 0.001). There was a trend of higher rates of sICH in patients aged ≥80 years compared with patients aged <80 years, whereas this did not reach statistical significance (OR = 1.28; 95% CI, 0.89-1.84; P = 0.18). Furthermore, the frequency of successful recanalization was also lower in patients aged ≥80 years compared with patients aged <80 years (OR = 0.72; 95% CI, 0.55-0.95; P = 0.02). The subgroup analysis indicated that in comparison with those studies published between 2014 and 2016, elderly patients undergoing MT had better outcomes in studies published between 2017 and 2019.Conclusion: Elderly patients undergoing MT had higher risk of mortality and worse functional outcome. Meanwhile, there was a trend toward higher rates of sICH and lower probability of achieving successful recanalization in elderly patients. These findings emphasize the need for improving the rates of successful recanalization in elderly patients Zhao et al.Mechanical Thrombectomy for Ischemic Stroke in Octogenarians with AIS. In addition, advanced technology of endovascular intervention and peri-interventional management might be associated with the prognosis in elderly patients. However, more prospective or randomized studies should be conducted to further explore this issue.

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“…A previous study examined the benefit of complete recanalisation (TICI 3) versus incomplete recanalisation (TICI 0-2b) in a series of 80 patients, dichotomised by age ≥80 years versus <80 years26. They found that independence at 90 days (mRs 0–2) was 65% in the older cohort and 68% in the younger cohort, when TICI 3 recanalisation was achieved, and 21% versus 45% for TICI 0-2b in the older and younger cohorts, respectively.…”

Section: Discussionmentioning

confidence: 99%

Association between age and outcomes following thrombectomy for anterior circulation emergent large vessel occlusion is determined by degree of recanalisation

Jayaraman

Kishkovich

Baird

et al. 2018

J NeuroIntervent Surg

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Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 80 Years or Older

Cited by 47 publications

References 11 publications

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study

Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis

Association between age and outcomes following thrombectomy for anterior circulation emergent large vessel occlusion is determined by degree of recanalisation

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