An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulation acute ischemic stroke: outcomes with respect to age.
age
direct aspiration
ischemic stroke
mechanical thrombectomy
revascularization
stent-retriever
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
06
05
2019
revised:
28
05
2019
accepted:
29
05
2019
pubmed:
27
6
2019
medline:
2
6
2020
entrez:
27
6
2019
Statut:
ppublish
Résumé
Thrombectomy is an efficacious treatment for acute ischemic stroke (AIS). However, relatively few studies to date have specifically examined the impact and clinical implications of age on outcomes for thrombectomy in anterior AIS. To provide a snapshot of patient metrics and outcomes with respect to age following thrombectomy for anterior AIS to supplement the current body of data for predictors of clinical outcomes in a real-world setting. Data were collected for 20 consecutive patients with AIS treated with thrombectomy at 15 high-volume stroke centers across North America between 2015 and 2016. Patients with anterior occlusions were dichotomized based on whether they were older or younger than 80 years. Ordinal logistic regression analyzed how clinical variables impacted disability using 90-day modified Rankin Scale (mRS) scores. Adequate revascularization (TICI ≥2B) was achieved in 92.3% of patients aged <80 years with an average 1.7±0.1 passes taken with the primary technique and in 88.0% of patients aged ≥80 years with an average 1.7±0.2 passes. Despite similar baseline characteristics, mRS scores were significantly higher in older patients postoperatively and at 90 days after intervention. Age was a significant predictor of 90-day mRS across the study population. This analysis affirms age is a significant determinant of 90-day mRS scores following thrombectomy for large vessel anterior AIS. Further investigation into risks faced by elderly patients during thrombectomy may provide actionable information to help refine patient selection and improve outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Thrombectomy is an efficacious treatment for acute ischemic stroke (AIS). However, relatively few studies to date have specifically examined the impact and clinical implications of age on outcomes for thrombectomy in anterior AIS.
OBJECTIVE
OBJECTIVE
To provide a snapshot of patient metrics and outcomes with respect to age following thrombectomy for anterior AIS to supplement the current body of data for predictors of clinical outcomes in a real-world setting.
METHODS
METHODS
Data were collected for 20 consecutive patients with AIS treated with thrombectomy at 15 high-volume stroke centers across North America between 2015 and 2016. Patients with anterior occlusions were dichotomized based on whether they were older or younger than 80 years. Ordinal logistic regression analyzed how clinical variables impacted disability using 90-day modified Rankin Scale (mRS) scores.
RESULTS
RESULTS
Adequate revascularization (TICI ≥2B) was achieved in 92.3% of patients aged <80 years with an average 1.7±0.1 passes taken with the primary technique and in 88.0% of patients aged ≥80 years with an average 1.7±0.2 passes. Despite similar baseline characteristics, mRS scores were significantly higher in older patients postoperatively and at 90 days after intervention. Age was a significant predictor of 90-day mRS across the study population.
CONCLUSION
CONCLUSIONS
This analysis affirms age is a significant determinant of 90-day mRS scores following thrombectomy for large vessel anterior AIS. Further investigation into risks faced by elderly patients during thrombectomy may provide actionable information to help refine patient selection and improve outcomes.
Identifiants
pubmed: 31239328
pii: neurintsurg-2019-015093
doi: 10.1136/neurintsurg-2019-015093
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
115-121Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: AHS: Financial Interest/Investor/Stock Options/Ownership: Imperative Care, Q’Apel Medical; Consultant/Advisory Board: Cerenovus, Imperative Care, Medtronic, MicroVention, Penumbra, Q’Apel Medical, Stryker. JE: Consultant: Stryker Neurovascular, Medtronic. AT: Consultant: BALT/Blockade, Cerenovus, Medtronic, Microvention-Terumo, Penumbra, Imperative Care, Stryker. KW: Consultant: Cerenovus, Medtronic, Microvention, Penumbra, Stryker. AR: Consultant: Stryker, Cerenovus, Microvention. BB: Consultant: Penumbra, Medtronic, Stryker; Shareholder: Penumbra. RH: Grant/Research Support: Medtronic, Stryker, Microvention; Consultant: Medtronic, Stryker, Cerenovus, Microvention, Balt. JEDA: Consultant: Penumbra, Medtronic, Microvention. ASA: Consultant: Cerenovus, Medtronic, Microvention, Penumbra, Stryker; Research Support: Microvention, Cerenovus, Penumbra. DFi: Consultant: Medtronic, Microvention, Penumbra, Balt, Cerenovus, Stryker; Research Support: Siemens, Microvention, Penumbra, Cerenovus. MK: Consultant: Penumbra, Medtronic. LP: Consultant: Medtronic. DFr: Consultant/Speakers Bureau: Penumbra, Stryker, Research support: Cerenovus, Medtronic, Microvention, Penumbra, Stryker; Stock ownership: Penumbra. IL: Consultant: Medtronic, Stryker, Cerenovus. RDL: Consultant: Cerenovus, Penumbra, Q’Apel Medical, Imperative Care, Mivi Neuroscience; Research support: Medtronic, Asahi Intec. JM: Consultant: Cerebrotech, Rebound Therapeutics, TSP, Lazarus Effect, Medina, Pulsar Vascular; Investor: Blockade, Medina, Lazarus Effect, TSP; Research support: Penumbra.