Zhao Weisong, Ma Pengju, Zhang Ping, Yue Xuejing
Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China.
Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
Front Neurol. 2020 Jan 24;10:1355. doi: 10.3389/fneur.2019.01355. eCollection 2019.
Multiple randomized trials have confirmed that mechanical thrombectomy (MT) is an effective treatment method for patients with acute ischemic stroke (AIS). However, evidence on the safety and efficacy of MT in elderly patients compared with younger patients is controversial. This meta-analysis is aimed to systematically compare the outcomes of elderly patients and younger patients after MT for AIS. A systematic literature search was conducted through the PubMed, EMBASE, and Cochrane Library database. The primary outcomes were favorable functional outcome at 90 days and mortality. The secondary outcomes were symptomatic intracerebral hemorrhage (sICH) and successful recanalization rate. Odds ratios (ORs) were estimated using a random effects model. Sixteen studies published between 2014 and 2019 were included in this meta-analysis totally involving 3,954 patients. The pooled results showed that patients aged ≥80 years had worse functional outcome (OR = 0.40; 95% CI, 0.32-0.50; < 0.001) and higher rates of mortality (OR = 2.26; 95% CI, 1.73-2.95; < 0.001). There was a trend of higher rates of sICH in patients aged ≥80 years compared with patients aged <80 years, whereas this did not reach statistical significance (OR = 1.28; 95% CI, 0.89-1.84; = 0.18). Furthermore, the frequency of successful recanalization was also lower in patients aged ≥80 years compared with patients aged <80 years (OR = 0.72; 95% CI, 0.55-0.95; = 0.02). The subgroup analysis indicated that in comparison with those studies published between 2014 and 2016, elderly patients undergoing MT had better outcomes in studies published between 2017 and 2019. Elderly patients undergoing MT had higher risk of mortality and worse functional outcome. Meanwhile, there was a trend toward higher rates of sICH and lower probability of achieving successful recanalization in elderly patients. These findings emphasize the need for improving the rates of successful recanalization in elderly patients with AIS. In addition, advanced technology of endovascular intervention and peri-interventional management might be associated with the prognosis in elderly patients. However, more prospective or randomized studies should be conducted to further explore this issue.
多项随机试验已证实，机械取栓术（MT）是急性缺血性卒中（AIS）患者的一种有效治疗方法。然而，与年轻患者相比，MT在老年患者中的安全性和有效性证据存在争议。本荟萃分析旨在系统比较老年患者和年轻患者接受MT治疗AIS后的结局。通过PubMed、EMBASE和Cochrane图书馆数据库进行了系统的文献检索。主要结局为90天时的良好功能结局和死亡率。次要结局为症状性脑出血（sICH）和成功再通率。使用随机效应模型估计比值比（OR）。本荟萃分析共纳入了2014年至2019年间发表的16项研究，共涉及3954例患者。汇总结果显示，年龄≥80岁的患者功能结局较差（OR = 0.40；95%CI，0.32 - 0.50；P < 0.001），死亡率较高（OR = 2.26；95%CI，1.73 - 2.95；P < 0.001）。与年龄<80岁的患者相比，年龄≥80岁的患者sICH发生率有升高趋势，但未达到统计学意义（OR = 1.28；95%CI，0.89 - 1.84；P = 0.18）。此外，与年龄<80岁的患者相比，年龄≥80岁的患者成功再通频率也较低（OR = 0.72；95%CI，0.55 - 0.95；P = 0.02）。亚组分析表明，与2014年至2016年间发表的研究相比，2017年至2019年间发表的研究中接受MT治疗的老年患者结局更好。接受MT治疗的老年患者死亡率风险更高，功能结局更差。同时，老年患者sICH发生率有升高趋势，成功再通的可能性较低。这些发现强调了提高AIS老年患者成功再通率的必要性。此外，先进的血管内介入技术和围介入管理可能与老年患者的预后有关。然而，应进行更多的前瞻性或随机研究以进一步探讨这一问题。
