Jeon Jin Pyeong, Kim Sung-Eun, Kim Chul Ho
Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, South Korea; Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, South Korea.
Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, South Korea.
Clin Neurol Neurosurg. 2017 Oct;161:70-77. doi: 10.1016/j.clineuro.2017.08.015. Epub 2017 Aug 30.
The aim of this study is to compare procedural outcomes after endovascular treatment (EVT) according to age (≥80 years vs. <80 years) and to examine treatment outcomes after mechanical thrombectomy using a stent retriever between the different age groups.
A systemic literature review of an online database of articles published from January 2004 to February 2017 was conducted. The primary outcome was successful recanalization in the final angiogram and symptomatic intracranial hemorrhage (S-ICH) after EVT. The secondary outcome was good clinical outcome and mortality at 3 months. A random-effect model was used in cases of heterogeneity over 50%.
Eight articles including 1711 patients compared outcomes according to age. Successful recanalization did not differ significantly between the two groups (≥80 years, n=214 (70.6%);<80years, n=1035 (73.5%); OR: 0.797; 95% CI: 0.599-1.060). Age ≥80 years did not significantly increase the risk of S-ICH (OR: 1.271; 95% CI: 0.784-2.060). Octogenarians showed lower good clinical outcome at 3 months (OR: 0.323; 95% CI: 0.233-0.448) and higher mortality (OR: 2.689; 95% CI: 2.050-3.527). Three studies including 670 patients (≥80 years, n=140;<80years, n=530) assessed outcomes after mechanical thrombectomy using a stent retriever. Successful recanalization (OR: 0.786; 95% CI: 0.507-1.218) and S-ICH (OR: 1.679; 95% CI: 0.918-3.071) did not significantly differ between the two groups.
Procedural outcomes such as successful recanalization and S-ICH after EVT in octogenarians are comparable to those seen in patients <80years. EVT is technically feasible to treat hyperacute stroke in octogenarians. Further large-scale studies dealing with various factors, such as occlusion site, stroke severity, comorbidities, and concomitant use of endovascular devices are required.
本研究旨在比较血管内治疗（EVT）后根据年龄（≥80岁与＜80岁）的手术结果，并研究不同年龄组使用支架取栓器进行机械取栓后的治疗结果。
对2004年1月至2017年2月发表的文章在线数据库进行系统文献综述。主要结局是最终血管造影中的成功再通以及EVT后的症状性颅内出血（S-ICH）。次要结局是3个月时的良好临床结局和死亡率。在异质性超过50%的情况下使用随机效应模型。
八项研究共1711例患者根据年龄比较了结局。两组之间成功再通无显著差异（≥80岁，n = 214（70.6%）；＜80岁，n = 1035（73.5%）；OR：0.797；95%CI：0.599 - 1.060）。≥80岁并未显著增加S-ICH的风险（OR：1.271；95%CI：0.784 - 2.060）。80岁及以上患者在3个月时显示出较低的良好临床结局（OR：0.323；95%CI：0.233 - 0.448）和较高的死亡率（OR：2.689；95%CI：2.050 - 3.527）。三项研究共670例患者（≥80岁，n = 140；＜80岁，n = 530）评估了使用支架取栓器进行机械取栓后的结局。两组之间成功再通（OR：0.786；95%CI：0.507 - 1.218）和S-ICH（OR：1.679；95%CI：0.918 - 3.071）无显著差异。
80岁及以上患者EVT后的手术结果如成功再通和S-ICH与＜80岁患者相当。EVT在技术上对于治疗80岁及以上患者的超急性卒中是可行的。需要进一步开展涉及各种因素（如闭塞部位、卒中严重程度、合并症以及血管内装置的联合使用）的大规模研究。
