Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients.
Publication/Presentation Date
4-1-2020
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.
Volume
132
Issue
4
First Page
1182
Last Page
1187
ISSN
1933-0693
Published In/Presented At
Andrews, C. E., Mouchtouris, N., Fitchett, E. M., Al Saiegh, F., Lang, M. J., Romo, V. M., Herial, N., Jabbour, P., Tjoumakaris, S. I., Rosenwasser, R. H., & Gooch, M. R. (2019). Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients. Journal of neurosurgery, 132(4), 1182–1187. https://doi.org/10.3171/2018.12.JNS182399
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
30925465
Department(s)
Administration and Leadership
Document Type
Article