Abomulay Manar, Desfontaines Philippe, Ciobanu Carla, Brisbois Denis, Cornet Olivier, Dister François, Delvoye François
Department of Neurology, Comprehensive Stroke Unit, CHC MontLegia, Liège, Belgium.
Department of Interventional Neuroradiology, CHC MontLegia, Liège, Belgium.
Acta Neurol Belg. 2025 Jul 21. doi: 10.1007/s13760-025-02846-4.
Little is known about predicting factors for a good outcome (GO) after endovascular treatment (EVT) performed for acute ischemic stroke (AIS) related to large vessel occlusion (LVO) in the over-80s population. We evaluate demographic and procedural predictors of GO from our prospective registry of patients treated during the acute phase of an LVO-related AIS.
GO was defined as a 3-month modified Rankin scale (mRS) [Formula: see text] 3 or equivalent to pre-stroke mRS. Univariate (UVA) and multivariate (MVA) analysis were performed to assess the factors' independent effect on the outcome. The magnitude of the between-group differences was assessed by calculating the standardized differences (StD). Variables with StD >0,2 were included in the MVA.
From 182 patients aged ≥ 80, 3-month GO was observed in 31.3% (57/182). The proportion of TICI ≥ 2c-3 was significantly lower in the poor outcome (PO) group compared to the GO group (52% versus 78.9%, StD = 0.591). In univariate logistic regression model, TICI ≥ 2c-3 is associated with a 277% increase in the chances of a GO (OR = 3.77, 95%CI 1.79-7.97, P < 0.001). This association remained significant in multivariate logistic regression model (aOR = 0.77, 95%CI 0.66-0.89, P = 0.000501) even when a hemorrhagic transformation (HT) occurs (p het = 0.57948).
We show that achieving a TICI score of 2c-3 seems to be the best predictive factor for the outcome in the elderly population. In this group, every effort should be made to achieve excellent recanalization.
对于80岁以上因大血管闭塞（LVO）导致急性缺血性卒中（AIS）而接受血管内治疗（EVT）后良好预后（GO）的预测因素知之甚少。我们从与LVO相关的AIS急性期治疗患者的前瞻性登记中评估GO的人口统计学和手术预测因素。
GO定义为3个月改良Rankin量表（mRS）[公式：见正文]≤3或等同于卒中前mRS。进行单因素（UVA）和多因素（MVA）分析以评估各因素对结局的独立影响。通过计算标准化差异（StD）评估组间差异的大小。StD>0.2的变量纳入MVA。
在182例年龄≥80岁的患者中，3个月时观察到GO的比例为31.3%（57/182）。与GO组相比，预后不良（PO）组中TICI≥2c-3的比例显著更低（52%对78.9%，StD = 0.591）。在单因素逻辑回归模型中，TICI≥2c-3与GO几率增加277%相关（OR = 3.77，95%CI 1.79-7.97，P < 0.001）。即使发生出血性转化（HT），这种关联在多因素逻辑回归模型中仍显著（校正OR = 0.77，95%CI 0.66-0.89，P = 0.000501）（p异质性 = 0.57948）。
我们表明，达到TICI 2c-3评分似乎是老年人群结局的最佳预测因素。在该组中，应尽一切努力实现良好的再通。
