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J Neurosurg. 2019 Mar 29:1-8. doi: 10.3171/2018.12.JNS182399. [Epub ahead of print]

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients.

Author information

1
1Sidney Kimmel Medical College, Thomas Jefferson University; and.
2
2Department of Neurological Surgery and.
3
3Division of Neurological Anesthesia, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.

Abstract

OBJECTIVE Mechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients. METHODS The authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old. RESULTS All groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results. CONCLUSIONS Octogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

KEYWORDS:

AIS = acute ischemic stroke; CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; DVT = deep vein thrombosis; MT = mechanical thrombectomy; NIHSS = National Institutes of Health Stroke Scale; PVD = peripheral vascular disease; TIA = transient ischemic attack; TICI = Thrombolysis in Cerebral Infarction; UTI = urinary tract infection; acute ischemic stroke; elderly; mRS = modified Rankin Scale; mechanical thrombectomy; tPA = tissue plasminogen activator; vascular disorders

PMID:
30925465
DOI:
10.3171/2018.12.JNS182399

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