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Clin Neurol Neurosurg. 2017 Oct;161:70-77. doi: 10.1016/j.clineuro.2017.08.015. Epub 2017 Aug 30.

Endovascular treatment of acute ischemic stroke in octogenarians: A meta-analysis of observational studies.

Author information

1
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea.
2
Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, South Korea.
3
Department of Neurology, Hallym University College of Medicine, Chuncheon, South Korea. Electronic address: gumdol52@naver.com.

Abstract

OBJECTIVES:

The aim of this study is to compare procedural outcomes after endovascular treatment (EVT) according to age (≥80 years vs. <80 years) and to examine treatment outcomes after mechanical thrombectomy using a stent retriever between the different age groups.

PATIENTS AND METHODS:

A systemic literature review of an online database of articles published from January 2004 to February 2017 was conducted. The primary outcome was successful recanalization in the final angiogram and symptomatic intracranial hemorrhage (S-ICH) after EVT. The secondary outcome was good clinical outcome and mortality at 3 months. A random-effect model was used in cases of heterogeneity over 50%.

RESULTS:

Eight articles including 1711 patients compared outcomes according to age. Successful recanalization did not differ significantly between the two groups (≥80 years, n=214 (70.6%);<80years, n=1035 (73.5%); OR: 0.797; 95% CI: 0.599-1.060). Age ≥80 years did not significantly increase the risk of S-ICH (OR: 1.271; 95% CI: 0.784-2.060). Octogenarians showed lower good clinical outcome at 3 months (OR: 0.323; 95% CI: 0.233-0.448) and higher mortality (OR: 2.689; 95% CI: 2.050-3.527). Three studies including 670 patients (≥80 years, n=140;<80years, n=530) assessed outcomes after mechanical thrombectomy using a stent retriever. Successful recanalization (OR: 0.786; 95% CI: 0.507-1.218) and S-ICH (OR: 1.679; 95% CI: 0.918-3.071) did not significantly differ between the two groups.

CONCLUSIONS:

Procedural outcomes such as successful recanalization and S-ICH after EVT in octogenarians are comparable to those seen in patients <80years. EVT is technically feasible to treat hyperacute stroke in octogenarians. Further large-scale studies dealing with various factors, such as occlusion site, stroke severity, comorbidities, and concomitant use of endovascular devices are required.

KEYWORDS:

Endovascular procedures; Meta-analysis; Octogenarians; Stent; Stroke; Thrombectomy

PMID:
28863285
DOI:
10.1016/j.clineuro.2017.08.015
[Indexed for MEDLINE]

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