Royal Perth Hospital, Western Australia, Australia.
Interventional Neuroradiologist, Neurological Intervention & Imaging Service of WA, Australia.
J Stroke Cerebrovasc Dis. 2024 Jul;33(7):107722. doi: 10.1016/j.jstrokecerebrovasdis.2024.107722. Epub 2024 Apr 12.
Our aim was to compare the outcomes of treatment with endovascular thrombectomy for pre-stroke dependent versus pre-stroke independent among the very elderly ≥90 years.
A retrospective cohort study was performed on 106 patients ≥90 years who underwent endovascular thrombectomy for ischaemic stroke in Western Australia between June 2016 and September 2021. Patient, stroke and procedural details along with inpatient progress and outcome at 90 days were recorded. Patients were divided into Group A (pre-stroke modified Rankin Scale 0-2) and Group B (pre-stroke modified Rankin Scale >2). Primary outcome measure was functional status at 90 days post-stroke, with favourable clinical outcome defined as a 90-day mRS category equal to the patients' respective pre-stroke mRS category. Secondary outcome measures include successful reperfusion, symptomatic intracranial haemorrhage, hospital length-of-stay, change in accommodation to an aged care facility, and mortality during admission, at 90 days and one year.
61 patients were allocated to Group A and 45 to Group B. There was none with pre-stroke mRS 5. Group B had more pre-existing cognitive impairment, aged care facility residents, higher median age and lower Alberta Stroke Program Early CT Score. For primary outcome measure, 38 % of patients in Group A and 49 % in Group B achieved a favourable clinical outcome. The difference was not significant (p=0.3408). For secondary outcome measures, Group B had a significantly higher 90-day mortality rate at 47 % versus 24 % in Group A (p=0.03). All other secondary outcome measures were similar between the two groups. These include the rate of successful reperfusion and symptomatic intracranial haemorrhage, hospital length-of-stay, new transition into an aged care facility, inpatient mortality rate and 1-year mortality rate.
When treated with endovascular thrombectomy for ischaemic stroke, nonagenarians with pre-existing dependency achieved a rate of favourable functional outcome comparable with their independent peers, although they also had higher 90-day mortality rate.
我们的目的是比较血管内血栓切除术治疗伴有和不伴有术前依赖的超高龄（≥90 岁）患者的预后。
这是一项在 2016 年 6 月至 2021 年 9 月期间，西澳大利亚州对 106 名接受血管内血栓切除术治疗缺血性脑卒中的≥90 岁超高龄患者进行的回顾性队列研究。记录了患者、卒中及手术相关细节，以及 90 天内的住院进展和结局。患者被分为 A 组（术前改良 Rankin 量表 0-2 分）和 B 组（术前改良 Rankin 量表＞2 分）。主要结局指标为卒中后 90 天的功能状态，良好的临床结局定义为 90 天 mRS 评分与患者术前 mRS 评分相同。次要结局指标包括再通成功率、症状性颅内出血、住院时间、入住老年护理机构的变化以及住院期间、90 天和 1 年的死亡率。
61 名患者被分配到 A 组，45 名患者被分配到 B 组。无一例患者术前 mRS 评分为 5 分。B 组患者术前认知障碍更多，入住老年护理机构，中位年龄更高，Alberta 卒中项目早期 CT 评分更低。在主要结局指标方面，A 组患者中有 38%，B 组患者中有 49%达到了良好的临床结局。差异无统计学意义（p=0.3408）。在次要结局指标方面，B 组 90 天死亡率为 47%，显著高于 A 组的 24%（p=0.03）。两组的其他次要结局指标相似，包括再通成功率、症状性颅内出血、住院时间、新入住老年护理机构、住院期间死亡率和 1 年死亡率。
对于接受血管内血栓切除术治疗的缺血性脑卒中超高龄患者，伴有术前依赖的患者达到了与独立患者相似的良好功能结局，但死亡率更高。
