Ali Aisha, Testai Fernando D, Trifan Gabriela
Department of Neurology and Rehabilitation, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
Cerebrovasc Dis. 2024;53(4):372-381. doi: 10.1159/000533204. Epub 2023 Oct 9.
Mechanical thrombectomy (MT) is recommended for large vessel occlusion (LVO) stroke. However, most of the studies that investigated the superiority of MT over best medical management (BMM) alone included preponderantly non-elderly patients. Thus, there is uncertainty in relation to the efficacy of MT in the elderly. We aim to compare the effect of BMM to BMM plus MT among elderly and non-elderly patients with LVO.
We performed a systematic search of medical databases from inception to April 2023 to identify randomized studies that reported the functional outcome at 90 days by age for patients with LVO treated with MT versus BMM. Patients were divided into elderly (>70 or >80 years, depending on the cutoff used in each study) and non-elderly. Outcomes were defined as excellent (modified Rankin Scale [mRS] ≤1), good (mRS ≤3), poor (mRS ≥5), or death. Effect sizes were calculated by using random effects meta-analyses. Results were represented by odds ratio (OR) and their 95% confidence intervals (95% CIs).
A total of 2,195 patients were included in the analysis (≥70 years, 7 trials, n = 696; ≥80 years, 2 trials, n = 139). Non-elderly patients treated with MT had higher odds of excellent outcome (OR: 3.05; 95% CI: 2.23-4.18) and good outcome (OR: 2.70; 95% CI: 1.94-3.74), and lower odds of poor outcome (OR: 0.54; 95% CI: 0.40-0.72) and death (OR: 0.63; 95% CI: 0.41-0.96). Similarly, elderly patients treated with MT had higher odds of excellent (OR: 2.39; 95% CI: 1.05-5.45) and good outcomes (OR: 2.18; 95% CI: 1.43-3.33) and lower odds of poor outcome (OR: 0.48; 95% CI: 0.33-0.70) and mortality (OR: 0.50; 0.26-0.95). When outcomes were analyzed by age subgroups, MT was associated with higher odds of good outcome in patients ≥70 years (OR: 1.95, 95% CI: 1.26-3.03) and ≥80 years (OR: 4.43, 95% CI: 1.02-19.23).
MT increases the likelihood of achieving a good outcome in elderly and non-elderly patients without increasing the risk of severe disability or death. MT, when otherwise clinically indicated, should be considered over BMM alone in both age groups.
对于大血管闭塞（LVO）性卒中，推荐采用机械取栓术（MT）。然而，大多数比较MT与单纯最佳药物治疗（BMM）疗效的研究主要纳入的是非老年患者。因此，MT在老年患者中的疗效尚不确定。我们旨在比较BMM与BMM联合MT在老年和非老年LVO患者中的效果。
我们对医学数据库进行了全面检索，涵盖从建库至2023年4月的文献，以确定随机对照研究，这些研究报告了接受MT或BMM治疗的LVO患者按年龄分组在90天时的功能预后。患者分为老年组（根据各研究采用的临界值，年龄>70岁或>80岁）和非老年组。预后定义为良好（改良Rankin量表[mRS]≤1）、较好（mRS≤3）、较差（mRS≥5）或死亡。采用随机效应荟萃分析计算效应量。结果以比值比（OR）及其95%置信区间（95%CI）表示。
共有2195例患者纳入分析（≥70岁，7项试验，n = 696；≥80岁，2项试验，n = 139）。接受MT治疗的非老年患者获得良好预后（OR：3.05；95%CI：2.23 - 4.18）和较好预后（OR：2.70；95%CI：1.94 - 3.74）的几率更高，而获得较差预后（OR：0.54；95%CI：0.40 - 0.72）和死亡（OR：0.63；95%CI：0.41 - 0.96）的几率更低。同样，接受MT治疗的老年患者获得良好（OR：2.39；95%CI：1.05 - 5.45）和较好预后（OR：2.18；95%CI：1.43 - 3.33）的几率更高，而获得较差预后（OR：0.48；95%CI：0.33 - 0.70）和死亡（OR：0.50；0.26 - 0.95）的几率更低。按年龄亚组分析预后时，MT与≥70岁（OR：1.95，95%CI：1.26 - 3.03）和≥80岁（OR：4.43，95%CI：1.02 - 19.23）患者获得较好预后的几率增加相关。
MT可提高老年和非老年患者获得良好预后的可能性，且不会增加严重残疾或死亡风险。在两个年龄组中，若临床有指征，应考虑采用MT而非单纯BMM。
