Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Neurological Surgery and Neuroradiology, University of Miami, Miami, Florida, USA.
J Neurointerv Surg. 2019 Jun;11(6):545-553. doi: 10.1136/neurintsurg-2018-014289. Epub 2018 Nov 2.
The efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial.
To evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared with younger patients.
Data from prospectively maintained databases of patients undergoing ET for AIS at seven US-based comprehensive stroke centers between January 2013 and January 2018 were reviewed. Demographic, procedural, and outcome variables were collected. Outcomes included 90-day modified Rankin Scale (mRS) score, postprocedural National Institutes of Health Stroke Scale score, postprocedural hemorrhage, and mortality. Univariate and multivariate analyses were performed to assess the independent effect of age ≥80 on outcome measures. Subgroup analyses were also performed based on location of stroke, success of recanalization, or ET technique used.
Rates of functional independence (mRS score 0-2) after ET in elderly patients were significantly lower than for younger counterparts. Age ≥80 was independently associated with increased mortality and poor outcome. Age ≥80 showed an independent negative prognostic effect on outcome even when patients were divided according to thrombectomy technique, location of stroke, or success of recanalization. Age ≥80 independently predicted higher rate of postprocedural hemorrhage, but not success of recanalization. Baseline deficit and number of reperfusion attempts, but not Thrombolysis in Cerebral Infarction score were associated with lower odds of good outcome.
The large effect size of ET on AIS outcomes is significantly diminished in the elderly population when using comparable selection criteria to those used in younger counterparts. This raises concerns about the risk-benefit ratio and the cost-effectiveness of performing this procedure in the elderly before optimizing patient selection.
血管内血栓切除术（ET）治疗 80 岁以上急性缺血性脑卒中（AIS）的疗效仍存在争议。
使用大型多中心患者队列评估与年轻患者相比，80 岁以上患者接受 ET 的结果。
回顾了 2013 年 1 月至 2018 年 1 月期间，在美国 7 个综合卒中中心接受 AIS 血管内治疗的患者前瞻性维护数据库中的数据。收集了人口统计学、程序和结果变量。结果包括 90 天改良 Rankin 量表（mRS）评分、术后 NIH 卒中量表评分、术后出血和死亡率。进行了单变量和多变量分析，以评估年龄≥80 对结局指标的独立影响。还根据卒中部位、再通成功率或使用的 ET 技术进行了亚组分析。
老年患者 ET 后功能独立性（mRS 评分 0-2）的比率明显低于年轻患者。年龄≥80 与死亡率和不良预后增加独立相关。即使根据血栓切除术技术、卒中部位或再通成功率对患者进行分组，年龄≥80 也与预后不良独立相关。年龄≥80 独立预测术后出血发生率更高，但不预测再通成功率。基线缺损和再灌注尝试次数，但不是溶栓评分与良好结局的可能性降低相关。
在使用与年轻患者相同的选择标准时，ET 对 AIS 结局的大影响在老年人群中明显减弱。这引发了对在优化患者选择之前，在老年人中进行该操作的风险效益比和成本效益的关注。
