Sin Long Hin, Lee Yat Sing, Lau Hin Yue, Chan Wai Tat, Siu Chi Wai, Tan Chong Boon
Department of Radiology and Nuclear Medicine, Neuroscience Center, Tuen Mun Hospital; Chinese University of Hong Kong, 60396979, Hong Kong.
Department of Radiology and Nuclear Medicine, Neuroscience Center, Tuen Mun Hospital; University of Hong Kong, 61022268, Hong Kong.
J Stroke Cerebrovasc Dis. 2025 Jan;34(1):108130. doi: 10.1016/j.jstrokecerebrovasdis.2024.108130. Epub 2024 Nov 17.
Elderly patients contribute to the large proportion of ischaemic stroke worldwide. Currently, treatment for elderly stroke remains aggressive, as the exact age cutoff for endovascular thrombectomy (EVT) has not been well established due to a lack of large-scale randomized control trials. In this study we investigate the difference in outcome after EVT in the octogenarian and above, compared to their younger counterparts.
EVT patients were divided into two groups, the octogenarian group and younger group (below age of 80). Primary outcome were the 90-days post-thrombectomy functional independence (modified Rankin scale), and Barthel index. Secondary and safety outcomes of post-thrombectomy were also analyzed, including reperfusion status (modified Thrombolysis in Cerebral Infarction (TICI) score), National Institutes of Health Stroke Scale (NIHSS), major complications and mortality rate.
A total 340 patients were included from 2020 to 29 Feb 2024, and patients' demographics were obtained. Poorer neurological outcome and functional independence were noted in octogenarian group compared with younger counterpart (OR 0.33; 95 % CI 0.14-0.51; p < 0.001). A slightly higher trend of overall post-procedural death was also identified in elder group compared with the younger group (OR 1.48; 95 % CI 0.85-2.60, p = 0.08). Subgroup analysis with more advanced age cutoff at 90 took a step further and proposed that advanced age resulting in more devastating neurological outcome.
Outcomes after endovascular thrombectomy in the elder group were significantly worse than their younger counterparts. More than 80 % of elder group who were treated with EVT required moderate functional dependence, and one in four were dead within 90-days post-EVT.
老年患者在全球缺血性卒中患者中占很大比例。目前，老年卒中的治疗仍然积极，由于缺乏大规模随机对照试验，血管内血栓切除术（EVT）的确切年龄界限尚未明确确立。在本研究中，我们调查了80岁及以上患者接受EVT后的结局与年轻患者的差异。
将接受EVT的患者分为两组，80岁及以上组和较年轻组（80岁以下）。主要结局为血栓切除术后90天的功能独立性（改良Rankin量表）和Barthel指数。还分析了血栓切除术后的次要结局和安全性结局，包括再灌注状态（改良脑梗死溶栓（TICI）评分）、美国国立卫生研究院卒中量表（NIHSS）、主要并发症和死亡率。
纳入了2020年至2024年2月29日期间的340例患者，并获取了患者的人口统计学数据。与较年轻组相比，80岁及以上组的神经功能结局和功能独立性较差（OR 0.33；95%CI 0.14 - 0.51；p < 0.001）。与较年轻组相比，老年组术后总体死亡趋势也略高（OR 1.48；95%CI 0.85 - 2.60，p = 0.08）。将年龄界限进一步提高到90岁的亚组分析进一步表明，高龄会导致更严重的神经功能结局。
老年组血管内血栓切除术后的结局明显比年轻组差。接受EVT治疗的老年组中，超过80%的患者需要中度功能依赖，四分之一的患者在EVT后90天内死亡。
