Burden of first-ever ischemic stroke in the oldest old

Marini, Carmine; Baldassarre, M.; Russo, Tommasina; Santis, Federica De; Sacco, Simona; Ciancarelli, Irene; Carolei, Antonio

doi:10.1212/01.wnl.0000101461.61501.65

Cited by 147 publications

(100 citation statements)

References 17 publications

(15 reference statements)

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“…The incidence of stroke rises significantly in the presence of multiple risk factors (Marini et al., 2004). Advanced age is a leading risk factor for stroke.…”

Section: Introductionmentioning

confidence: 99%

Immediate and late outcomes of stenting for severe extracranial internal carotid artery stenosis in octogenarian patients

Duan

Dai

et al. 2017

Brain and Behavior

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BackgroundMultiple studies suggest that internal carotid artery stenting can be performed safely in octogenarians with low periprocedural complication rates. However, great concern still exists as to whether these patients will gain long‐term benefits from this procedure given their advanced age and uncertain life expectancy. We decided to conduct a retrospective study to determine short‐and long‐term clinical outcomes and to analyze survival duration in this population.Methods and ResultsSixty‐nine consecutive elderly patients with either symptomatic or asymptomatic stenosis ≥70% underwent 86 procedures. Immediate and late outcomes, as well as survival data, were analyzed retrospectively. Mean age was 83.1 ± 2.7 years. Mean survival was 49.3 ± 10.1 months. A complete neurological assessment was obtained at 1 and 2 years in 100% of patients, at 3 years in 90.7% of patients and at 5 years in 84.8% of patients. Two major and one minor ischemic strokes occurred during the periprocedural period. No death, myocardial infarction or intracranial hemorrhage was recorded. The mean follow‐up period was 55.4 ± 24.6 months. Four patients experienced a minimum of 1 year of follow‐up, and the longest is 8 years. Among the patients with the longest follow‐up time, 6 had ischemic strokes, of which 2 were fatal. In total, 17 deaths occurred. Four patients experienced dementia without stroke. Survival at 3 and 5 years was estimated to be 90% and 73%, respectively.ConclusionThis study demonstrated that stenting in octogenarians was safe and effective during the periprocedural period. Long‐term follow‐up showed a low rate of fatal and nonfatal stroke, and patients survived long enough to benefit from the procedure. However, it was associated with a relatively high rate of long‐term event. Though carotid artery stenting is a minimally invasive procedure, it should still be performed with great caution and only in carefully selected patients. The present study suggested that in this age population, carotid artery stenting might be considered as a revascularization option.

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“…The incidence of stroke rises significantly in the presence of multiple risk factors (Marini et al., 2004). Advanced age is a leading risk factor for stroke.…”

Section: Introductionmentioning

confidence: 99%

Immediate and late outcomes of stenting for severe extracranial internal carotid artery stenosis in octogenarian patients

Duan

Dai

et al. 2017

Brain and Behavior

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“…In China, there have been no such studies. Therefore, there is a urgent need to confirm the safety and efficacy of rt-PA in these patients [4,5]. The present study aimed to reveal whether rt-PA could be safely and efficiently used on Chinese patients [80 years old with acute ischemic stroke.…”

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confidence: 98%

“…A small number of studies have investigated the efficacy of rt-PA for elderly stroke patients in Japanese and Caucasian populations [4,5]. According to the American Heart Association/American Stroke Association Guidelines, patients over 80 years of age can be selected for rt-PA thrombolysis [6] and the Third International Stroke Trial found that the benefit of rt-PA did not diminish in patients older than 80 years [7].…”

mentioning

confidence: 99%

“…However, the Chinese Guidelines for Stroke Management do not recommend rt-PA thrombolysis for these patients, due to the possibility that it increases the risk of intracranial hemorrhage transformation and subsequent nosocomial mortality [8]. In addition, an epidemiological study in Europe showed that [30% of the people included in their study who were [80 years old developed ischemic stroke after rt-PA treatment [5]. In China, there have been no such studies.…”

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confidence: 99%

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Analysis of the Efficacy and Safety of Recombinant Tissue Plasminogen Activator for Chinese Patients over 80 Years of Age with Acute Ischemic Stroke: A Pilot Study

et al. 2016

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“…1 Although >80-yearold patients with stroke have 2-fold higher mortality and morbidity even with thrombolysis compared with ≤80-yearold patients, 2,3 pooled results of thrombolysis and neuroprotection trials suggest potential for benefit with thrombolysis in >80-year-old patients. 4 This may be important for patients wake-up ischemic stroke (WUIS), who are significantly older, constitute 14% of acute presentations, and 36% may be eligible for thrombolysis.…”

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confidence: 99%

Influence of Age on Thrombolysis Outcome in Wake-Up Stroke

Manawadu¹,

Bodla

Keep³

et al. 2013

Stroke

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Background and Purpose— Thrombolysis in patients >80 years remains controversial; we hypothesized that >80-year-old patients with wake-up ischemic stroke (WUIS) will benefit from thrombolysis despite risks because of poor outcomes with no treatment. Methods— The study included 68 thrombolysed patients with WUIS (33 [48%] >80 years), 54 nonthrombolysed patients with WUIS (21 [39%] >80 years), and 117 patients (>80 years old) thrombolysed within 4.5 hours of symptom onset (reference group). Mortality and modified Rankin Scale (mRS) were assessed at 90 days. Results— Baseline characteristics of thrombolysed and nonthrombolysed >80 and ≤80-year-old patients with WUIS were comparable. Thrombolysis outcomes in >80-year-old patients with WUIS were better than in nonthrombolysed >80-year-old patients with WUIS (90-day mortality: 24% versus 47%, P =0.034; mRS 0–2: 30% versus 5%, P =0.023; mRS 0–1: 15% versus 5%, P =0.24) and comparable with thrombolysed ≤80-year-old patients with WUIS. Thrombolysis was associated with odds ratio 0.27 (95% confidence interval, 0.05–0.97) for mortality and odds ratio 28.6 (95% confidence interval, 1.8–448) for mRS 0 to 2 at 90 days in >80-year-old patients with WUIS after adjusting for stroke severity and risk factors. Conclusions— Thrombolysis may be associated with greater benefit in >80-year-old patients with WUIS but a selection bias favoring thrombolysis in those most likely to benefit may significantly reduce interpretability of these findings.

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Burden of first-ever ischemic stroke in the oldest old

Abstract: The burden of ischemic stroke is high in subjects 80 years old or older, contributing about one-third of health care utilization and 59.8% of deaths within 30 days.

Cited by 147 publications

References 17 publications

Immediate and late outcomes of stenting for severe extracranial internal carotid artery stenosis in octogenarian patients

Immediate and late outcomes of stenting for severe extracranial internal carotid artery stenosis in octogenarian patients

Analysis of the Efficacy and Safety of Recombinant Tissue Plasminogen Activator for Chinese Patients over 80 Years of Age with Acute Ischemic Stroke: A Pilot Study

Influence of Age on Thrombolysis Outcome in Wake-Up Stroke

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