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

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 12; pp. 2793 - 2799
• Main Authors: Imahori, Taichiro, Tanaka, Kazuhiro, Arai, Atsushi, Shiomi, Ryoji, Fujiwara, Daigo, Mori, Tatsuya, Yokote, Akiyoshi, Matsushima, Kazushi, Matsui, Daisaku, Kobayashi, Makoto, Fujita, Atsushi, Hosoda, Kohkichi, Kohmura, Eiji
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2017
• Subjects: Acute ischemic stroke; Age Factors; Aged; Aged, 80 and over; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Brain Ischemia - therapy; Cerebral Angiography - methods; Clinical Decision-Making; Computed Tomography Angiography; Disability Evaluation; elderly; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Endovascular Procedures - mortality; endovascular treatment; Female; Humans; Logistic Models; Male; mechanical thrombectomy; Multivariate Analysis; Odds Ratio; Retrospective Studies; Risk Factors; Stroke - diagnosis; Stroke - mortality; Stroke - therapy; Thrombectomy - adverse effects; Thrombectomy - instrumentation; Thrombectomy - methods; Thrombectomy - mortality; Time Factors; Treatment Outcome; mechanical thrombectomy; endovascular treatment; Acute ischemic stroke; elderly
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.060

There are limited data about the prognostic factors predicting outcomes after mechanical thrombectomy with stent retrievers for the elderly. Here, we evaluated outcomes in elderly patients in a real-world setting.
Between April 2015 and January 2017, 80 patients with anterior intracranial acute large vessel occlusion, who had lived independently before ictus, were treated with mechanical thrombectomy using a stent retriever at our institute. We compared outcomes between patients ≥80 years old (n = 36) and those <80 years old (n = 44), and assessed prognostic factors for favorable outcomes (modified Rankin Scale score 0-2) at 90 days in all patients.
There was no significant difference in baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score between the 2 groups. Successful revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] scores 2b/3) (83% versus 93%, P = .286), complete recanalization (mTICI 3) (47% versus 50%, P = .826), and favorable outcomes (42% versus 57%, P = .261) were achieved more often in those <80 years old, but differences did not reach statistical significance. Multivariate regression analysis showed that baseline National Institutes of Health Stroke Scale (P = .013) and mTICI scores of 3 (P = .006) were significant predictive factors, but being ≥80 years old and baseline Alberta Stroke Program Early Computed Tomography Score were not. In those ≥80 years old, mTICI score of 3 was an influential factor for favorable outcome (P = .017).
Being aged 80 years or older was not a significant predictor for outcomes after mechanical thrombectomy, whereas complete recanalization was an influential predictor of outcome in the elderly.