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. 2018 Sep-Oct;32(5):1223-1230.
doi: 10.21873/invivo.11368.

Mechanical Thrombectomy of Large Artery Occlusion Is Beneficial in Octogenarians

Simo Karhi  1   2 , Ossi Nerg  3   4 , Tuuli Miettinen  3   4 , Emmi Mäkipaakkanen  3   4 , Mikko Taina  5   2 , Hannu Manninen  5   2 , Ritva Vanninen  5   2 , Pekka Jäkälä  3   4
Affiliations

Mechanical Thrombectomy of Large Artery Occlusion Is Beneficial in Octogenarians

Simo Karhi et al. In Vivo. 2018 Sep-Oct.

Abstract

Aim: Recent trials have established the benefit of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to large artery occlusion (LAO). However, older patients were often excluded from trials. EVT outcomes were retrospectively compared between octogenarians and younger patients treated for LAO in a tertiary hospital.

Patients and methods: A total of 199 consecutive patients with anterior circulation AIS that underwent EVT between 2009 and 2015 in the Kuopio University Hospital were included. Patients were dichotomized into younger (<80 years, N=162) and older (≥80 years, N=37) groups. Baseline, imaging, and procedural characteristics, the 3-month modified Rankin Scale (mRS), and 1-year mortality were assessed. To conduct a number-needed-to-treat (NNT) analysis, data on age-dichotomized control groups from a meta-analysis were acquired.

Results: Compared to younger patients, older patients exhibited atrial fibrillation (57% vs. 21%, p<0.01) and coronary artery disease (49% vs. 20%, p<0.01) more frequently and Internal Carotid Artery (ICA) occlusion less frequently (22% vs. 55%, p<0.01). Similar proportions of patients received preprocedural intravenous recombinant tissue-type plasminogen activator (r-tPA; 57% vs. 67%), general anesthesia (35% vs. 41%), and reperfusion (Thrombolysis in Cerebral Infarction scale 2b/3; 76% vs. 75%). Older patients had more complications during hospitalization (41% vs. 24%, p=0.034), higher 3-month mRS values (4.0±2.3 vs. 2.8±1.9, p<0.01), fewer favorable mRS values (mRS≤2: 27% vs. 52%, p<0.01), and higher 3-month (46% vs. 10% p<0.01) and 1-year mortality (49% vs. 11%, p<0.01). The NNT to achieve an additional patient with an independent outcome (mRS≤2) was 12 among older and six among younger patients.

Conclusion: Despite a poor recovery rate, octogenarians benefitted from EVT for AIS, with a NNT comparable to that of younger patients treated with intravenous r-tPA.

Keywords: Cerebrovascular stroke; cerebral infarction; elderly; endovascular procedures; octogenarian; thrombectomy.

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Figures

Figure 1
Figure 1. Functional outcome before and after thrombectomy for acute ischemic stroke. Distributions of modified Rankin Scale (mRS) points for both groups (A) and change in mRS observed 3 months after the onset of stroke for the younger (B) and older (C) age groups.
Figure 2
Figure 2. National Institute of Health Stroke Scale (NIHSS) points and Collateral Scores of patients aged under 80 years. Median NIHSS points (represented by horizontal lines) declined with increase in Collateral Scores of patients under 80 years old (p<0.01), but not for older patients (p≥0.05, not shown). Boxes mark the upper and lower quartiles and vertical bars represent the lowest and the highest values, circles representing outlier measurements.
Figure 3
Figure 3. Functional outcome and Collateral Scores of patients agedunder 80 years. Inverse relationship between collateral scores andmedian 3-month modified Rankin Scale points (represented by lines) foryounger patients (p<0.01), but not for older patients (p≥0.05, notshown). Boxes mark the upper and lower quartiles and vertical barsrepresent the lowest and the highest values, circles representing outliermeasurements.
See this image and copyright information in PMC

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