Pinto Mafalda Mendes, Nunes Ana Paiva, Alves Marta, Papoila Ana Luísa, Pamplona Jaime, Carvalho Rui, Baptista Mariana, Reis João, Fragata Isabel
Functional Area of Neuroradiology, Medical Imaging Department - Centro Hospitalar Universitário de Coimbra.
Cerebrovascular Unit - Hospital de São José, Centro Hospitalar Universitário de Lisboa Central.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105015. doi: 10.1016/j.jstrokecerebrovasdis.2020.105015. Epub 2020 Jun 16.
Mechanical thrombectomy is the standard treatment in acute ischemic stroke due to large vessel occlusion, but there is limited evidence about its efficacy in very old patients. We sought to analyse safety and effectiveness of mechanical thrombectomy in nonagenarian versus octagenarian patients.
We included consecutive patients with acute ischemic stroke due to large vessel occlusion subjected to mechanical thrombectomy, during 29 months in a tertiary center. Patients were divided into two sub-groups, according to age: 80-89 and >90 years old. Recanalization, complications, functional outcome and mortality at discharge and at 3 months were compared. Multivariable analysis was performed to identify independent predictors of functional outcome at 3 months of follow-up, assessed by the modified Rankin Scale.
A total of 128 octogenarians (88.9%) and 16 nonagenarians (11.1%) met the inclusion criteria. Successful revascularization was achieved in 87.5% of octagenarians and in 81.3% of nonagenarians (p = 0.486). Symptomatic hemorrhage occurred in 3.1% and 6.3% of younger and older patients, respectively (p = 0.520). Cerebral edema occured in 35.2% of octagenarians versus 25.0% of nonagenarians (p = 0.419). Functional independence (mRS ≤ 2) at 3 months was achieved in 28 (22.6%) and 5 (31.3%) of octagenarians and nonagenarians, respectively (p = 0.445). Mortality at 3 months was not significantly higher in nonagenarians (37.5%) versus octagenarians (33.9%, p = 0.773).
No significant diferences were found in functional outcome, mortality, recanalization and complication rates between octagenarians and nonagenarians submitted to mechanical thrombectomy, underlining that patients should not be excluded from mechanical thrombectomy based on age alone.
机械取栓术是治疗大血管闭塞所致急性缺血性卒中的标准方法，但关于其在高龄患者中的疗效证据有限。我们试图分析非agenarian与octagenarian患者行机械取栓术的安全性和有效性。
我们纳入了在一家三级中心连续29个月接受机械取栓术的因大血管闭塞导致急性缺血性卒中的患者。根据年龄将患者分为两个亚组：80 - 89岁和90岁以上。比较再通情况、并发症、功能结局以及出院时和3个月时的死亡率。进行多变量分析以确定随访3个月时功能结局的独立预测因素，采用改良Rankin量表进行评估。
共有128名octagenarian（88.9%）和16名nonagenarian（11.1%）符合纳入标准。87.5%的octagenarian和81.3%的nonagenarian实现了成功再血管化（p = 0.486）。有症状性出血分别发生在年轻患者和老年患者中的比例为3.1%和6.3%（p = 0.520）。脑水肿在octagenarian中发生率为35.2%，在nonagenarian中为25.0%（p = 0.419）。3个月时功能独立（改良Rankin量表评分≤2）的octagenarian和nonagenarian分别为28例（22.6%）和5例（31.3%）（p = 0.445）。3个月时nonagenarian的死亡率（37.5%）与octagenarian（33.9%）相比无显著更高（p = 0.773）。
在接受机械取栓术的octagenarian和nonagenarian之间，在功能结局、死亡率、再通率和并发症发生率方面未发现显著差异，这表明不应仅基于年龄就将患者排除在机械取栓术之外。
