From the Departments of Neurology (A.C.C., O.O.Z., M.A.I.), Neurosurgery (O.O.Z.), and Radiology (O.O.Z.), Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI; Departments of Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Departments of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.A.T.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S., R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.E.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); Texas Stroke Institute, Plano, TX (V.J., A.A.-C.); University of Texas Health Science Center, Houston, TX (H.S.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.).
Stroke. 2014 Dec;45(12):3631-6. doi: 10.1161/STROKEAHA.114.006487. Epub 2014 Oct 30.
The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.
The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into ≤80 and >80 years of age.
Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were ≤80 years and 78 were >80 years of age. Mean age in the ≤80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score ≤2 versus 45.4% ≤80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and ≤80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.
Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.
SWIFT（Solitaire 取栓装置治疗急性缺血性卒中的前瞻性多中心随机研究）和 TREVO 2（机械取栓治疗急性大血管闭塞性卒中血管内再通的临床试验）研究结果表明机械取栓可提高再通率；然而，老年人的结局仍知之甚少。在此，我们报告北美 Solitaire-FR 支架取栓装置急性卒中注册研究（NASA）中年龄对临床和血管造影结局的影响。
NASA 注册研究招募了接受 Solitaire-FR 治疗的连续患者的治疗数据。通过将队列分为≤80 岁和＞80 岁两个年龄组，评估年龄对临床和血管造影结局的影响。
24 个中心共 354 例患者接受治疗；276 例患者≤80 岁，78 例患者＞80 岁。≤80 岁和＞80 岁两组的平均年龄分别为 62.2±13.2 岁和 85.2±3.8 岁。＞80 岁的患者中有 27.3%在 90 天时改良 Rankin 评分≤2，而≤80 岁的患者有 45.4%（P=0.02）。＞80 岁和≤80 岁两组的死亡率分别为 43.9%和 27.3%（P=0.01）。两组间再通时间、再通成功率和症状性颅内出血无显著差异。多变量分析显示，年龄＞80 岁是临床结局不良和死亡率的独立预测因素。在＞80 岁组中，美国国立卫生研究院卒中量表（NIHSS）评分、再通率、挽救性治疗的使用和症状性颅内出血是死亡率的独立预测因素。
与 NASA 注册研究中的年轻患者相比，年龄＞80 岁与较差的临床结局和更高的死亡率相关。然而，静脉注射组织型纤溶酶原激活剂的使用、较低的 NIHSS 评分和较短的再通时间与更好的结局相关。需要进一步研究来了解与药物治疗相比，血管内治疗在这一组中的作用。
