Department of Neurology, Helsinki University Hospital and University of Helsinki, 00029 HUS, Haartmaninkatu 4, Finland.
Department of Neurology, Helsinki University Hospital and University of Helsinki, 00029 HUS, Haartmaninkatu 4, Finland.
J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106816. doi: 10.1016/j.jstrokecerebrovasdis.2022.106816. Epub 2022 Oct 8.
Data concerning the results of endovascular thrombectomy (EVT) in old patients is still limited. We aimed to investigate the outcomes in thrombectomy-treated ischemic stroke patients aged ≥ 80 years, focusing on frailty as a contributing factor.
We performed a single-centre retrospective cohort study with 159 consecutive patients aged ≥ 80 years and treated with EVT for acute ischemic stroke between January 1st 2016 and December 31st 2019. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS). Patients with CFS ≥ 5 were defined as frail. The main outcome was very poor outcome defined as mRS 4-6 at three months after EVT. Secondary outcomes were recanalization status, symptomatic intracerebral haemorrhage (sICH), and one-year survival. Finally, we recorded if the patient returned home within 12 months.
Very poor outcome was observed in 57.9% of all patients (52.4% in non-frail and 79.4% in frail patients). Rates of recanalization and sICH were comparable in frail and non-frail patients. Of all patients, 46.5% were able to live at home within 1 year after stroke. One-year survival was 59.1% (65.6% in non-frail and 35.3% in frail patients). In logistic regression analysis higher admission NIHSS, not performing thrombolysis, lack of recanalization and higher frailty status were all independently associated with very poor three-month outcome. Factors associated with one-year mortality were male gender, not performing thrombolysis, sICH, and higher frailty status.
Almost 60% of studied patients had very poor outcome. Frailty significantly increases the likelihood of very poor outcome and death after EVT-treated stroke.
关于老年患者血管内血栓切除术（EVT）结果的数据仍然有限。我们旨在研究接受 EVT 治疗的年龄≥80 岁的血栓切除术治疗的缺血性脑卒中患者的结局，重点关注衰弱作为一个促成因素。
我们进行了一项单中心回顾性队列研究，纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间接受 EVT 治疗的 159 例年龄≥80 岁的急性缺血性脑卒中连续患者。使用临床虚弱量表（CFS）评估入院前虚弱程度。CFS≥5 分的患者定义为虚弱。主要结局为 EVT 后 3 个月 mRS 4-6 的极差结局。次要结局为再通状态、症状性颅内出血（sICH）和 1 年生存率。最后，我们记录了患者是否在 12 个月内回家。
所有患者中有 57.9%（非虚弱组为 52.4%，虚弱组为 79.4%）的患者预后极差。虚弱组和非虚弱组的再通率和 sICH 率相似。所有患者中，46.5%的患者在脑卒中后 1 年内能够在家中生活。1 年生存率为 59.1%（非虚弱组为 65.6%，虚弱组为 35.3%）。在逻辑回归分析中，较高的入院 NIHSS、未进行溶栓治疗、未再通和较高的虚弱状态均与 3 个月时极差结局独立相关。与 1 年死亡率相关的因素为男性、未进行溶栓治疗、sICH 和较高的虚弱状态。
研究中近 60%的患者预后极差。衰弱显著增加 EVT 治疗后中风患者预后极差和死亡的可能性。
