Efficacy of Endovascular Therapy in Acute Ischemic Stroke Depends on Age and Clinical Severity

Abstract

In patients stratified with the SC score, EVT was associated with improved functional outcome in older and more severe patients but not in younger and less severe patients.

Comorbidities Related to Clinical Outcomes in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: Review of Literature and Experience at a Single Comprehensive Stroke Center

“…Recent studies (2013-2018) have demonstrated the benefits of mechanical thrombectomy (MT) in patients with acute ischemic stroke as a result of large vessel occlusion. [1][2][3][4][5] Identifying which patients are most likely to benefit from MT remains at the forefront of stroke research.…”

“…6 Several studies have explored the impact of age, diabetes mellitus, smoking habits, atrial fibrillation, hyperten-sion, hyperlipidemia, coronary artery disease, and peripheral artery disease on clinical outcomes in patients undergoing MT. [1][2][3][4][5] The randomized controlled DAWN trial compared the effect of MT 6-24 hours after the stroke in select patients vs medical therapy alone. The researchers found that age >80 years (given a prespecified infarct volume) and diabetes mellitus were associated with functional nonindependence at 90 days.…”

“…5 Le Bouc et al showed that MT was associated with improved functional outcome in older (ࣙ50 years) and more severe patients (based on National Institutes of Health Stroke Scale [NIHSS] scores) but not in younger and less severe patients. 4 Le Bouc et al created a stroke checkerboard score to incorporate age and stroke severity determined via the NIHSS. For their stroke checkerboard score, 1 point was given per decade ࣙ50 years of age and 2 points were given per 5 points on the NIHSS.…”

“…For their stroke checkerboard score, 1 point was given per decade ࣙ50 years of age and 2 points were given per 5 points on the NIHSS. 4 An analysis of 4,079 patients with acute ischemic stroke showed that stroke checkerboard scores <8 were predictive of good outcomes (modified Rankin Scale [mRS] score of 0-2) in patients not treated with MT, whereas stroke checkerboard scores >12 were predictive of poor outcomes (mRS score of 4-6). 4 MT was associated with good outcomes (mRS score of 0-2) in patients with stroke checkerboard scores >12 (common OR 1.70; 95% CI 1.13-2.56) and stroke checkerboard scores of 8-12 (OR 1.37; 95% CI 1.11-1.69) but not in patients with stroke checkerboard scores <8 (OR 0.72; 95% CI 0.56-0.93).…”

“…4 An analysis of 4,079 patients with acute ischemic stroke showed that stroke checkerboard scores <8 were predictive of good outcomes (modified Rankin Scale [mRS] score of 0-2) in patients not treated with MT, whereas stroke checkerboard scores >12 were predictive of poor outcomes (mRS score of 4-6). 4 MT was associated with good outcomes (mRS score of 0-2) in patients with stroke checkerboard scores >12 (common OR 1.70; 95% CI 1.13-2.56) and stroke checkerboard scores of 8-12 (OR 1.37; 95% CI 1.11-1.69) but not in patients with stroke checkerboard scores <8 (OR 0.72; 95% CI 0.56-0.93). 4 The common OR in this study refers to the increased chance of achieving a functionally independent outcome within certain sets of the stroke checkerboard scoring system.…”