Lima Andrey, Haussen Diogo C, Rebello Leticia C, Dehkharghani Seena, Grossberg Jonathan, Grigoryan Mikayel, Frankel Michael, Nogueira Raul G
Emory University School of Medicine/Marcus Stroke and Neuroscience Center - Grady Memorial Hospital, Atlanta, Ga., USA.
Cerebrovasc Dis. 2016;42(5-6):421-427. doi: 10.1159/000446852. Epub 2016 Jul 26.
Acute ischemic stroke (AIS) in the elderly encompasses approximately one-third of all AIS cases. Outcome data have been for the most part discouraging in this population. We aim to evaluate the outcomes in a large contemporary series of elderly patients treated with thrombectomy.
Retrospective analysis of a single-center endovascular database for consecutive elderly (≥80 years) patients treated for anterior circulation large vessel occlusion AIS between September 2010 and April 2015. Univariate- and multivariate analyses were performed to identify the predictors of good clinical outcome (90-day modified Ranking Scale [mRS] ≤2). Receiver operating characteristic curves were used to calculate the optimal final infarct volume (FIV) threshold to predict good outcomes.
A total of 111 patients met our inclusion criteria (mean age 84.8 ± 4.2 years; National Institutes of Health Stroke Scale [NIHSS] score 19.1 ± 5.6; time from last-known normal to puncture, 349.6 ± 246.6 min; 33% male; 68% Alberta Stroke Program Early CT Score [ASPECTS] ≥8). The rates of successful reperfusion (modified treatment in cerebral ischemia ≥2b), symptomatic intracranial hemorrhage and 90-day mortality were 80%, 7% and 41%, respectively. The overall rate of good outcome was 29% (n = 32/111) but was 52% (n = 13/25) in patients with baseline mRS score of 0-2 who were selected based on CT perfusion and treated with stent retrievers. On multivariate analysis, only ASPECTS (OR 2.17; 95% CI 1.28-3.67.7; p = 0.004) and baseline NIHSS score (OR 0.87; 95% CI 0.77-0.97; p = 0.013) were independently associated with good outcome. A FIV ≤16 ml demonstrated the greatest accuracy for identifying good outcomes (sensitivity 75.0%, specificity 82.6%).
Our results are encouraging demonstrating nearly one-third of elderly patients achieving full independence at 90 days. Contemporary treatment paradigms employing optimized patient selection and modern thrombectomy technology may result in even better outcomes.
老年急性缺血性卒中（AIS）约占所有AIS病例的三分之一。该人群的预后数据大多令人沮丧。我们旨在评估当代大量接受血栓切除术治疗的老年患者的预后情况。
对2010年9月至2015年4月期间在单中心血管内数据库中接受治疗的连续性老年（≥80岁）前循环大血管闭塞性AIS患者进行回顾性分析。进行单因素和多因素分析以确定良好临床预后（90天改良Rankin量表[mRS]≤2）的预测因素。使用受试者工作特征曲线计算预测良好预后的最佳最终梗死体积（FIV）阈值。
共有111例患者符合我们的纳入标准（平均年龄84.8±4.2岁；美国国立卫生研究院卒中量表[NIHSS]评分19.1±5.6；从最后已知正常到穿刺的时间为349.6±246.6分钟；男性占33%；68%的阿尔伯塔卒中项目早期CT评分[ASPECTS]≥8）。成功再灌注（脑缺血改良治疗≥2b）、症状性颅内出血和90天死亡率分别为80%、7%和41%。良好预后的总体发生率为29%（n = 32/111），但在根据CT灌注选择并接受支架取栓器治疗的基线mRS评分为0 - 2的患者中为52%（n = 13/25）。多因素分析显示，只有ASPECTS（比值比[OR]2.17；95%置信区间[CI]1.28 - 3.67；p = 0.004）和基线NIHSS评分（OR 0.87；95% CI 0.77 - 0.97；p = 0.013）与良好预后独立相关。FIV≤16 ml在识别良好预后方面显示出最高的准确性（敏感性75.0%，特异性82.6%）。
我们的结果令人鼓舞，表明近三分之一的老年患者在90天时实现了完全独立。采用优化的患者选择和现代血栓切除术技术的当代治疗模式可能会带来更好的结果。
