TICI and Age: What's the Score?

Slater, Lee-Anne; Coutinho, Jonathan M.; Gralla, Jan; Nogueira, Raul G; Bonafé, Alain; Dávalos, Antoni; Jahan, Reza; Levy, Elad I.; Baxter, Blaise; Saver, Jeffrey L.; Pereira, Vítor Mendes

doi:10.3174/ajnr.a4618

Cited by 17 publications

(8 citation statements)

References 31 publications

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“…Third, our data suggest that the lower rates of functional independence in octogenarians are not explained by lower recanalization, the thrombectomy approach used, or the location of the stroke. In contrast, prior work has shown that successful recanalization resulted in higher odds of good outcomes in patients aged ≥70 years compared with younger counterparts 33. This effect was not seen in our data when we used multivariate analysis controlling for additional variables, including complications, onset-to-groin time, number of recanalization attempts, and location of stroke (anterior vs posterior).…”

Section: Discussioncontrasting

confidence: 93%

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

Alawieh

Starke

Chatterjee

et al. 2018

J NeuroIntervent Surg

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BackgroundThe efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial.ObjectiveTo evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared with younger patients.MethodsData from prospectively maintained databases of patients undergoing ET for AIS at seven US-based comprehensive stroke centers between January 2013 and January 2018 were reviewed. Demographic, procedural, and outcome variables were collected. Outcomes included 90-day modified Rankin Scale (mRS) score, postprocedural National Institutes of Health Stroke Scale score, postprocedural hemorrhage, and mortality. Univariate and multivariate analyses were performed to assess the independent effect of age ≥80 on outcome measures. Subgroup analyses were also performed based on location of stroke, success of recanalization, or ET technique used.ResultsRates of functional independence (mRS score 0–2) after ET in elderly patients were significantly lower than for younger counterparts. Age ≥80 was independently associated with increased mortality and poor outcome. Age ≥80 showed an independent negative prognostic effect on outcome even when patients were divided according to thrombectomy technique, location of stroke, or success of recanalization. Age ≥80 independently predicted higher rate of postprocedural hemorrhage, but not success of recanalization. Baseline deficit and number of reperfusion attempts, but not Thrombolysis in Cerebral Infarction score were associated with lower odds of good outcome.ConclusionThe large effect size of ET on AIS outcomes is significantly diminished in the elderly population when using comparable selection criteria to those used in younger counterparts. This raises concerns about the risk–benefit ratio and the cost-effectiveness of performing this procedure in the elderly before optimizing patient selection.

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Section: Discussioncontrasting

confidence: 93%

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

Alawieh

Starke

Chatterjee

et al. 2018

J NeuroIntervent Surg

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“…Interestingly, infection did not enter the logistic regression models for either prognostic outcome (favorable outcome or death at day 90). In our study, however, we confirmed the prognostic significance of several factors previously shown to be related to long-term prognosis in patients treated with MT, such as age [33], sex [34], time from stroke onset to groin puncture [35], recanalization after MT [33,36], and hemorrhagic transformation on CT after the procedure [33]. We also observed for the first time that lower delta NIHSS -which in our study reflects the neurological improvement after the procedure -was an independent factor affecting favorable outcome at day 90.…”

Section: Discussionsupporting

confidence: 88%

Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Nowak

Derbisz

Pęksa³

et al. 2020

pwki

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Introduction The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear. Aim Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke. Material and methods We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality. Results We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures. Conclusions In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.

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“…The subset of adults over 80 years of age have also been found to benefit from mechanical thrombectomy as a treatment for ischemic stroke, suggesting that there might be no upper age limit for the utility of thrombectomies. This is in accordance with recent research suggesting that patients older than 70 years of age benefit the most from successful reperfusion following mechanical thrombectomy (23).…”

Section: Prevalence Of Thrombectomiessupporting

confidence: 93%

Changing Trends in Hyperacute Stroke Treatment and Early Clinical Outcomes Reflecting Recent Improvement in Endovascular Thrombectomy Techniques

Davidson

Chakraborty

2017

UOJM

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Objective: Ischemic stroke is a major disease causing death and permanent neurological disability with the mainstay treatment being to re-established blood flow as quickly as possible. Recent changes in the efficiency of endovascular devices performing thrombectomies have led to it now being considered the gold standard. Nevertheless, successful endovascular thrombectomy (EVT) requires access to many resources and expertise which may impact its effectiveness. The objective of the current study is to describe the application and utility of EVT in the clinical treatment of ischemic stroke at a single tertiary care hospital. Methods: This is a descriptive retrospective cohort study from a stroke database. A total of 548 patients diagnosed with an ischemic stroke affecting large cerebral arteries between January 2010 and June 2016 were included. National Institute of Health Stroke Scale (NIHSS) score was used to evaluate stroke severity upon admission. Modified Ranking Scale was used to determine the functional status of patients upon discharge. Successful reperfusion defined as a TICI score of 2B or 3, age, thrombolytic use and time- to-treatment were all considered for analysis. Results: Thrombectomies became more frequent (p<0.001) with shorter time-to-treatment in recent years (p=0.001). A successful thrombectomy has significantly improved functional status at discharge (p<0.001), even when thrombolytics were not given (p=0.003) or when patients were over 80 years old (p=0.021). Conclusion: The current work provides evidence that this single hospital has increased its frequency of application of EVT for ischemic stroke, leading to a better functional outcome at discharge independent of prior thrombolysis or age.

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TICI and Age: What's the Score?

Abstract: BACKGROUND AND PURPOSE:Previous studies have suggested that advanced age predicts worse outcome following mechanical thrombectomy. We assessed outcomes from 2 recent large prospective studies to determine the association among TICI, age, and outcome.

Cited by 17 publications

References 31 publications

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Changing Trends in Hyperacute Stroke Treatment and Early Clinical Outcomes Reflecting Recent Improvement in Endovascular Thrombectomy Techniques

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