Cunningham Conor, Hubbard Zachary, Abo Kasem Rahim, Elawady Sameh Samir, Sowlat Mohammad-Mahdi, Matsukawa Hidetoshi, Maier Ilko, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Q, Rai Ansaar T, Starke Robert M, Psychogios Marios-Nikos, Samaniego Edgar A, Goyal Nitin, Yoshimura Shinichi, Cuellar Hugo, Howard Brian M, Alawieh Ali, Alaraj Ali, Ezzeldin Mohamad, Romano Daniele G, Tanweer Omar, Mascitelli Justin R, Fragata Isabel, Polifka Adam J, Siddiqui Fazeel, Osbun Joshua W, Grandhi Ramesh, Crosa Roberto Javier, Matouk Charles, Park Min S, Levitt Michael R, Brinjikji Waleed, Moss Mark, Daglioglu Ergun, Williamson Richard, Navia Pedro, Kan Peter, De Leacy Reade Andrew, Chowdhry Shakeel A, Altschul David, Al Kasab Sami, Spiotta Alejandro M
Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Neurology, Houston Methodist Hospital, Houston, Texas, USA.
J Neurointerv Surg. 2025 Jun 1;17(e2):e206-e215. doi: 10.1136/jnis-2024-022677.
The elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early CT Score (ASPECTS) (≤5).
This study analyzed data from a prospectively maintained database of 37 thrombectomy centers. The primary cohort of the study comprised patients with LVO-AIS aged ≥80 who underwent EVT with ASPECTS≤5 from 2013 to 2023. The primary outcome was favorable modified Rankin Scale (mRS) score of 0-3. Propensity score matching (PSM) and multivariate regression were applied.
In a study of 14 233 patients undergoing EVT, 1741 patients were 80 or older, with 122 presenting with low ASPECTS. While successful recanalization rates were similar between age groups, patients aged ≥80 had significantly lower favorable 90-day mRS scores and higher mortality before propensity score matching (PSM). After PSM, differences in mortality and symptomatic intracranial hemorrhage (sICH) were no longer significant. Among all elderly patients, higher ASPECTS was an independent predictor of a 90-day favorable outcome but was not associated with 90-day mortality. For patients aged ≥80 years with low ASPECTS, favorable outcomes were associated only with lower rates of atrial fibrillation, baseline functioning (mRS 0-1), fewer thrombectomy passes, and higher likelihood of first-pass reperfusion within 30 min of puncture.
While age ≥80 increases mortality and disability in patients with AIS and low ASPECTS, select elderly patients may still benefit from EVT when clinical factors are considered, supporting individualized treatment and better patient selection for future trials.
在近期针对前循环大血管闭塞急性缺血性卒中（LVO-AIS）且阿尔伯塔卒中项目早期CT评分（ASPECTS）较低（≤5分）的血管内血栓切除术（EVT）试验中，老年人群（≥80岁）的代表性不足。
本研究分析了来自37个血栓切除术中心前瞻性维护数据库的数据。该研究的主要队列包括2013年至2023年期间年龄≥80岁、接受ASPECTS≤5分的EVT治疗的LVO-AIS患者。主要结局是改良Rankin量表（mRS）评分为0-3分的良好预后。应用倾向评分匹配（PSM）和多变量回归分析。
在一项对14233例接受EVT治疗的患者的研究中，1741例患者年龄在80岁及以上，其中122例ASPECTS评分较低。虽然各年龄组的成功再通率相似，但年龄≥80岁的患者在倾向评分匹配（PSM）前，90天mRS良好评分显著较低，死亡率较高。PSM后，死亡率和症状性颅内出血（sICH）的差异不再显著。在所有老年患者中，较高的ASPECTS评分是90天良好预后的独立预测因素，但与90天死亡率无关。对于年龄≥80岁且ASPECTS评分较低的患者，良好预后仅与较低的房颤发生率、基线功能状态（mRS 0-1）、较少的血栓切除术次数以及穿刺后30分钟内首次通过再灌注的较高可能性相关。
虽然年龄≥80岁会增加AIS且ASPECTS评分较低患者的死亡率和残疾率，但在考虑临床因素时，部分老年患者仍可能从EVT中获益，这支持了个体化治疗，并为未来试验提供了更好的患者选择依据。
