Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neuroradiology, University Hospital Muenster, Muenster, Germany.
JAMA Netw Open. 2024 Aug 1;7(8):e2426007. doi: 10.1001/jamanetworkopen.2024.26007.
Randomized clinical trials have demonstrated the efficacy and safety of endovascular thrombectomy for acute ischemic stroke with large infarct. Patients older than 80 years with large infarct are commonly encountered in clinical practice but underrepresented in randomized clinical trials.
To provide an age-based analysis of functional outcomes in endovascular thrombectomy for acute ischemic strokes with large infarct.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective multicenter cohort study included patients from the German Stroke Registry who received endovascular thrombectomy for acute ischemic stroke with large infarct at 1 of 25 German stroke centers between May 2015 and December 2021. Patients with acute ischemic stroke due to anterior circulation large vessel occlusion and large infarct were included. Large infarct was defined as an Alberta Stroke Program Early Computed Tomography Score of 0 to 5. Patients were subdivided by age to evaluate its association with functional outcomes.
Age.
Primary outcomes were independent ambulation (90-day modified Rankin Scale score of 0-3) and mortality (90-day modified Rankin Scale score of 6).
A total of 408 patients with large infarct were included (217 women [53.2%]; median [IQR] age, 75 [64-83] years). The rate of independent ambulation decreased from 56.4% in patients aged 60 years and younger (44 of 78 patients) to 15.1% in patients older than 80 years (19 of 126 patients) (P < .001), while mortality increased from 15.4% (12 patients) to 64.3% (81 patients) (P < .001). Being older than 80 years was associated with lower rates of independent ambulation (adjusted odds ratio [aOR], 0.44; 95% CI, 0.23-0.82; P = .01) and higher mortality (aOR, 2.75; 95% CI, 1.61-4.72; P < .001). A final modified Thrombolysis in Cerebral Infarction grade of 2b or 3 was associated with higher rates of independent ambulation (aOR, 4.95; 95% CI, 2.14-11.43; P < .001), independent of age and without significant interaction (aOR, 0.69; 95% CI, 0.35-1.34; P = .27).
In this cohort study of patients with acute ischemic stroke and large infarct, age was associated with functional outcomes. Patients older than 80 years had poor prognosis with high mortality but with sizeable differences depending on additional baseline and treatment characteristics. While it does not seem justified to apply a fixed upper age limit for endovascular thrombectomy, these results could assist clinicians in making informed treatment decisions in older patients with large ischemic stroke.
随机临床试验已经证明了血管内血栓切除术治疗大面积梗死的急性缺血性中风的疗效和安全性。在临床实践中，经常会遇到年龄大于 80 岁且伴有大面积梗死的患者，但这些患者在随机临床试验中代表性不足。
根据年龄对血管内血栓切除术治疗大面积梗死的急性缺血性中风患者的功能结局进行分析。
设计、地点和参与者：这是一项回顾性多中心队列研究，纳入了德国中风登记处的患者，他们在 2015 年 5 月至 2021 年 12 月期间在德国 25 家中风中心中的 1 家接受了血管内血栓切除术治疗大面积梗死的急性缺血性中风。纳入了因前循环大血管闭塞和大面积梗死导致急性缺血性中风的患者。大面积梗死定义为 Alberta Stroke Program 早期计算机断层扫描评分 0-5 分。根据年龄对患者进行亚组分析，以评估其与功能结局的关系。
年龄。
主要结局为独立行走（90 天改良 Rankin 量表评分为 0-3 分）和死亡率（90 天改良 Rankin 量表评分为 6 分）。
共纳入 408 例大面积梗死患者（217 例女性[53.2%]；中位[IQR]年龄 75 [64-83]岁）。在 60 岁及以下的患者中，独立行走的比例从 56.4%（78 例中的 44 例）降至 80 岁以上的患者中 15.1%（126 例中的 19 例）（P < .001），而死亡率从 15.4%（12 例）升至 64.3%（81 例）（P < .001）。年龄大于 80 岁与较低的独立行走率相关（校正优势比[OR]，0.44；95%CI，0.23-0.82；P = .01）和较高的死亡率相关（校正 OR，2.75；95%CI，1.61-4.72；P < .001）。最终改良血栓切除术治疗脑梗死评分 2b 或 3 级与更高的独立行走率相关（校正 OR，4.95；95%CI，2.14-11.43；P < .001），独立于年龄且无显著交互作用（校正 OR，0.69；95%CI，0.35-1.34；P = .27）。
在这项急性缺血性中风伴大面积梗死患者的队列研究中，年龄与功能结局相关。80 岁以上的患者死亡率较高，预后较差，但根据基线和治疗特征的不同，差异较大。虽然对血管内血栓切除术应用固定的最大年龄限制似乎是不合理的，但这些结果可以帮助临床医生在年龄较大的大面积缺血性中风患者中做出明智的治疗决策。
