Neurosurgery and Radiology, Stanford University Medical Center, Stanford, California, USA.
Department of Radiology, Stanford University, Stanford, California, USA.
J Neurointerv Surg. 2020 Mar;12(3):266-270. doi: 10.1136/neurintsurg-2019-015147. Epub 2019 Jul 26.
Multiple randomized trials have shown that endovascular thrombectomy (EVT) leads to improved outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Elderly patients were poorly represented in these trials, and the efficacy of EVT in nonagenarian patients remains uncertain.
We performed a retrospective cohort study at a single center. Inclusion criteria were: age 80-99, LVO, core infarct <70 mL, and salvageable penumbra. Patients were stratified into octogenarian (80-89) and nonagenarian (90-99) cohorts. The primary outcome was the ordinal score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included dichotomized functional outcome (mRS ≤2 vs mRS ≥3), successful revascularization, symptomatic intracranial hemorrhage (ICH), and mortality.
108 patients met the inclusion criteria, including 79 octogenarians (73%) and 29 nonagenarians (27%). Nonagenarians were more likely to be female (86% vs 58%; p<0.01); there were no other differences between groups in terms of demographics, medical comorbidities, or treatment characteristics. Successful revascularization (TICI 2b-3) was achieved in 79% in both cohorts. Median mRS at 90 days was 5 in octogenarians and 6 in nonagenarians (p=0.09). Functional independence (mRS ≤2) at 90 days was achieved in 12.5% and 19.7% of nonagenarians and octogenarians, respectively (p=0.54). Symptomatic ICH occurred in 21.4% and 6.4% (p=0.03), and 90-day mortality rate was 63% and 40.9% (p=0.07) in nonagenarians and octogenarians, respectively.
Nonagenarians may be at higher risk of symptomatic ICH than octogenarians, despite similar stroke- and treatment-related factors. While there was a trend towards higher mortality and worse functional outcomes in nonagenarians, the difference was not statistically significant in this relatively small retrospective study.
多项随机试验表明，血管内血栓切除术（EVT）可改善大动脉闭塞（LVO）导致的急性缺血性脑卒中（AIS）患者的预后。这些试验中老年人的代表性较差，90 岁以上患者的 EVT 疗效仍不确定。
我们在一家单中心进行了一项回顾性队列研究。纳入标准为：年龄 80-99 岁、LVO、核心梗死<70mL、可挽救半影区。患者分为 80-89 岁的 80 岁组和 90-99 岁的 90 岁组。主要结局为 90 天改良 Rankin 量表（mRS）的等级评分。次要结局包括二分类的功能结局（mRS≤2 与 mRS≥3）、再通成功、症状性颅内出血（ICH）和死亡率。
108 例患者符合纳入标准，包括 79 例 80 岁组（73%）和 29 例 90 岁组（27%）。90 岁组女性患者更多（86%比 58%；p<0.01）；两组在人口统计学、合并症和治疗特征方面无其他差异。两组再通率（TICI 2b-3）均为 79%。80 岁组和 90 岁组 90 天 mRS 中位数分别为 5 和 6（p=0.09）。90 天功能独立性（mRS≤2）分别为 12.5%和 19.7%（p=0.54）。症状性 ICH 发生率分别为 21.4%和 6.4%（p=0.03），90 天死亡率分别为 63%和 40.9%（p=0.07）。
尽管 90 岁组的卒中相关和治疗相关因素与 80 岁组相似，但 90 岁组发生症状性 ICH 的风险可能更高。尽管在这项相对较小的回顾性研究中，90 岁组的死亡率和功能结局较差，但差异无统计学意义。
