血管内血栓切除术治疗急性缺血性脑卒中可改善和维持超高龄患者的功能：一项多中心倾向评分匹配分析。
Endovascular thrombectomy for acute ischaemic stroke improves and maintains function in the very elderly: A multicentre propensity score matched analysis.
机构信息
Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.
出版信息
Eur Stroke J. 2023 Mar;8(1):191-198. doi: 10.1177/23969873221145778. Epub 2022 Dec 28.
INTRODUCTION
The very elderly (⩾80 years) are under-represented in randomised endovascular thrombectomy (EVT) clinical trials for acute ischaemic stroke. Rates of independent outcome in this group are generally lower than the less-old patients but the comparisons may be biased by an imbalance of non-age related baseline characteristics, treatment related metrics and medical risk factors.
PATIENTS AND METHODS
We compared outcomes between very elderly (⩾80) and the less-old (<80 years) using retrospective data from consecutive patients receiving EVT from four comprehensive stroke centres in New Zealand and Australia. We used propensity score matching or multivariable logistic regression to account for confounders.
RESULTS
We included 600 patients (300 in each age cohort) after propensity score matching from an initial group of 1270 patients. The median baseline National Institutes of Health Stroke Scale was 16 (11-21), with 455 (75.8%) having symptom free pre-stroke independent function, and 268 (44.7%) receiving intravenous thrombolysis. Good functional outcome (90-day modified Rankin Scale 0-2) was achieved in 282 (46.8%), with very elderly patients having less proportion of good outcome compared to the less-old (118 (39.3%) vs 163 (54.3%), < 0.01). There was no difference between the very elderly and the less-old in the proportion of patients who returned to baseline function at 90 days (56 (18.7%) vs 62 (20.7%), = 0.54). All-cause 90-day mortality was higher in the very elderly (75 (25%) vs 49 (16.3%), < 0.01), without a difference in symptomatic haemorrhage (very elderly 11 (3.7%) vs 6 (2.0%), = 0.33). In the multivariable logistic regression models, the very elderly were significantly associated with reduced odds of good 90-day outcome (OR 0.49, 95% CI 0.34-0.69, < 0.01) but not with return to baseline function (OR 0.85, 90% CI 0.54-1.29, = 0.45) after adjusting for confounders.
CONCLUSION
Endovascular thrombectomy can be successfully and safely performed in the very elderly. Despite an increase in all-cause 90-day mortality, selected very elderly patients are as likely as younger patients with similar baseline characteristics to return to baseline function following EVT.
简介
在急性缺血性脑卒中的随机血管内血栓切除术（EVT）临床试验中，高龄（≥80 岁）患者的代表性不足。该组患者独立预后的发生率通常低于年轻患者，但由于基线特征、治疗相关指标和医疗风险因素的不平衡，这些比较可能存在偏倚。
患者和方法
我们使用来自新西兰和澳大利亚 4 家综合卒中中心的连续接受 EVT 的患者的回顾性数据，比较了非常高龄（≥80 岁）和低龄（<80 岁）患者的预后。我们使用倾向评分匹配或多变量逻辑回归来调整混杂因素。
结果
在对来自 1270 名患者的初始组进行倾向评分匹配后，我们纳入了 600 名患者（每组 300 名）。中位基线国立卫生研究院卒中量表为 16（11-21），455 名（75.8%）患者在卒中前有独立的无症状功能，268 名（44.7%）接受了静脉溶栓治疗。良好的功能预后（90 天改良 Rankin 量表 0-2）在 282 名（46.8%）患者中得到了实现，高龄患者的良好预后比例低于低龄患者（118 名（39.3%）vs 163 名（54.3%），<0.01）。在 90 天内恢复基线功能的患者比例方面，高龄患者与低龄患者之间没有差异（56 名（18.7%）vs 62 名（20.7%），=0.54）。90 天全因死亡率在高龄患者中更高（75 名（25%）vs 49 名（16.3%），<0.01），但症状性出血无差异（高龄患者 11 名（3.7%）vs 6 名（2.0%），=0.33）。在多变量逻辑回归模型中，高龄患者的 90 天良好预后的可能性显著降低（OR 0.49，95%CI 0.34-0.69，<0.01），但与恢复基线功能的可能性无差异（OR 0.85，90%CI 0.54-1.29，=0.45），调整混杂因素后。
结论
血管内血栓切除术可安全有效地用于高龄患者。尽管全因 90 天死亡率增加，但与基线特征相似的年轻患者相比，选定的高龄患者在接受 EVT 后，同样有可能恢复到基线功能。
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