Beumer Debbie, Rozeman Anouk D, Lycklama À Nijeholt Geert J, Brouwer Patrick A, Jenniskens Sjoerd F M, Algra Ale, Boiten Jelis, Schonewille Wouter, van Oostenbrugge Robert J, Dippel Diederik W J, van Zwam Wim H
Department of Neurology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Oxfordlaan 10, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
BMC Neurol. 2016 May 17;16:68. doi: 10.1186/s12883-016-0592-5.
In recent randomized controlled trials (RCTs) intra-arterial treatment (IAT) has been proven effective and safe for patients with acute ischemic stroke (AIS). So far, there seemed to be no interaction between older age (>80) and main treatment effect. We studied the association of older age with outcome and adverse events after IAT in a cohort of intra arterially treated patients.
Data from all AIS patients with proven proximal anterior circulation cerebral artery occlusion who were intra arterially treated between 2002 until the start of the MR CLEAN trial were studied retrospectively. Duration of the procedure, recanalization (Thrombolysis In Cerebral Infarction score (TICI)), early neurological recovery (i.e. decrease on NIHSS of ≥ 8 points) after one week or at discharge, good functional outcome at discharge by modified Rankin Scale (mRS ≤ 2) and the occurrence of neurological and non-neurological adverse events were assessed and the association with age was investigated. In total 315 patients met our inclusion criteria. Median age was 63 years (range 22-93) and 17 patients (5.4%) were over 80. Age was inversely associated with good functional outcome (adjusted Odds Ratio (aOR) 0.80, 95% CI: 0.66-0.98) for every 10 years increase of age. Age was not associated with longer duration of the procedure, lower recanalization rate or less early neurological recovery. The risk of all adverse events (aOR 1.27; 95% CI: 1.08-1.50) and non-neurological adverse events (aOR 1.34; 95% CI: 1.11-1.61) increased, but that of peri-procedural adverse events (aOR 0.79; 95% CI: 0.66-0.94) decreased with age.
Higher age is inversely associated with good functional outcome after IAT in patients with AIS. However, treatment related adverse events are not related to age. These findings may help decision making when considering treatment of older patients with AIS.
在近期的随机对照试验（RCT）中，动脉内治疗（IAT）已被证明对急性缺血性卒中（AIS）患者有效且安全。到目前为止，高龄（>80岁）与主要治疗效果之间似乎没有相互作用。我们在一组接受动脉内治疗的患者中研究了高龄与IAT后结局及不良事件之间的关联。
对2002年至MR CLEAN试验开始期间所有经动脉内治疗且已证实近端前循环脑动脉闭塞的AIS患者的数据进行回顾性研究。评估手术持续时间、再通情况（脑梗死溶栓评分（TICI））、一周后或出院时的早期神经功能恢复（即美国国立卫生研究院卒中量表（NIHSS）评分降低≥8分）、出院时改良Rankin量表（mRS≤2）评估的良好功能结局以及神经和非神经不良事件的发生情况，并研究其与年龄的关联。共有315例患者符合我们的纳入标准。中位年龄为63岁（范围22 - 93岁），17例患者（5.4%）年龄超过80岁。年龄每增加10岁，良好功能结局的调整优势比（aOR）为0.80（95%置信区间：0.66 - 0.98），呈负相关。年龄与手术持续时间延长、再通率降低或早期神经功能恢复较少无关。所有不良事件（aOR 1.27；95%置信区间：1.08 - 1.50）和非神经不良事件（aOR 1.34；95%置信区间：1.11 - 1.61）的风险随年龄增加而增加，但围手术期不良事件的风险（aOR 0.79；95%置信区间：0.66 - 0.94）随年龄降低。
在AIS患者中，高龄与IAT后良好功能结局呈负相关。然而，与治疗相关的不良事件与年龄无关。这些发现可能有助于在考虑治疗老年AIS患者时进行决策。
