Karhi Simo, Nerg Ossi, Miettinen Tuuli, Mäkipaakkanen Emmi, Taina Mikko, Manninen Hannu, Vanninen Ritva, Jäkälä Pekka
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
In Vivo. 2018 Sep-Oct;32(5):1223-1230. doi: 10.21873/invivo.11368.
Recent trials have established the benefit of endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) due to large artery occlusion (LAO). However, older patients were often excluded from trials. EVT outcomes were retrospectively compared between octogenarians and younger patients treated for LAO in a tertiary hospital.
A total of 199 consecutive patients with anterior circulation AIS that underwent EVT between 2009 and 2015 in the Kuopio University Hospital were included. Patients were dichotomized into younger (<80 years, N=162) and older (≥80 years, N=37) groups. Baseline, imaging, and procedural characteristics, the 3-month modified Rankin Scale (mRS), and 1-year mortality were assessed. To conduct a number-needed-to-treat (NNT) analysis, data on age-dichotomized control groups from a meta-analysis were acquired.
Compared to younger patients, older patients exhibited atrial fibrillation (57% vs. 21%, p<0.01) and coronary artery disease (49% vs. 20%, p<0.01) more frequently and Internal Carotid Artery (ICA) occlusion less frequently (22% vs. 55%, p<0.01). Similar proportions of patients received preprocedural intravenous recombinant tissue-type plasminogen activator (r-tPA; 57% vs. 67%), general anesthesia (35% vs. 41%), and reperfusion (Thrombolysis in Cerebral Infarction scale 2b/3; 76% vs. 75%). Older patients had more complications during hospitalization (41% vs. 24%, p=0.034), higher 3-month mRS values (4.0±2.3 vs. 2.8±1.9, p<0.01), fewer favorable mRS values (mRS≤2: 27% vs. 52%, p<0.01), and higher 3-month (46% vs. 10% p<0.01) and 1-year mortality (49% vs. 11%, p<0.01). The NNT to achieve an additional patient with an independent outcome (mRS≤2) was 12 among older and six among younger patients.
Despite a poor recovery rate, octogenarians benefitted from EVT for AIS, with a NNT comparable to that of younger patients treated with intravenous r-tPA.
近期试验已证实血管内治疗（EVT）对因大动脉闭塞（LAO）导致的急性缺血性卒中（AIS）患者有益。然而，老年患者通常被排除在试验之外。在一家三级医院中，对接受LAO治疗的八旬老人和年轻患者的EVT结果进行回顾性比较。
纳入2009年至2015年在库奥皮奥大学医院连续接受EVT治疗的199例前循环AIS患者。患者被分为年轻组（<80岁，n = 162）和老年组（≥80岁，n = 37）。评估基线、影像学和手术特征、3个月改良Rankin量表（mRS）以及1年死亡率。为进行需治疗人数（NNT）分析，获取了一项荟萃分析中按年龄分层的对照组数据。
与年轻患者相比，老年患者房颤（57%对21%，p<0.01）和冠状动脉疾病（49%对20%，p<0.01）更为常见，颈内动脉（ICA）闭塞则较少见（22%对55%，p<0.01）。接受术前静脉注射重组组织型纤溶酶原激活剂（r - tPA）的患者比例相似（57%对67%），全身麻醉（35%对41%）以及再灌注（脑梗死溶栓量表2b/3；76%对75%）的比例也相似。老年患者住院期间并发症更多（41%对24%，p = 0.034），3个月mRS值更高（4.0±2.3对2.8±1.9，p<0.01），mRS良好值（mRS≤2）更少（27%对52%，p<0.01），3个月（46%对10%，p<0.01）和1年死亡率更高（49%对11%，p<0.01）。在老年患者中，要多获得1例独立预后（mRS≤2）患者的NNT为12，而年轻患者中为6。
尽管恢复率较低，但八旬老人从AIS的EVT中获益，其NNT与接受静脉r - tPA治疗的年轻患者相当。
