Endovascular Treatment of Anterior Circulation Large Vessel Occlusion in the Elderly

Jayaraman, Mahesh; McTaggart, Ryan

doi:10.3389/fneur.2017.00713

Cited by 23 publications

(18 citation statements)

References 46 publications

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“…Our findings showing poor outcomes after ET are consistent with prior single arm studies, as previously reviewed by Jayaraman et al 20 and as reported in an earlier meta-analysis 21. Some studies attributed worse outcomes in the elderly to potential higher comorbidities, procedural variables, and impaired collaterals 20–22.…”

Section: Discussionsupporting

confidence: 92%

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

Alawieh

Chatterjee

Feng

et al. 2018

J NeuroIntervent Surg

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Section: Discussionsupporting

confidence: 92%

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

Alawieh

Chatterjee

Feng

et al. 2018

J NeuroIntervent Surg

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“…We demonstrate that an age of ≥72 years is a negative predictor of poor outcome in patients with anterior circulation occlusion but does not independently predict an increased rate of functional dependence in the posterior circulation group. Our findings and those of previous studies have consistently shown that age is an independent predictor of functional independence and mortality after thrombectomy in elderly patients with acute anterior circulation stroke [ 14 , 15 ]. Although the BASICS study demonstrated that mechanical thrombectomy is safe for acute circulation stroke, its effectiveness has not yet been confirmed [ 16 ].…”

Section: Discussionsupporting

confidence: 88%

“…The verification of the internal validation group (training group) by bootstrap analysis further confirmed the reliability of the present nomogram. Although several studies have examined the relationship between risk predictors and stroke outcome after mechanical thrombectomy [ 14 , 15 , 20 ], there is growing evidence that nomograms have a better performance than risk predictors [ 10 , 11 ]. In contrast to the risk group, a nomogram model provides a visualized and individualized estimate of the prediction probability of a specific outcome for an individual patient, as well as an important tool of medical decision-making based on the individual's disease characteristics.…”

Section: Discussionmentioning

confidence: 99%

Nomogram to Predict Poor Outcome after Mechanical Thrombectomy at Older Age and Histological Analysis of Thrombus Composition

Meng

Wang

Yang

et al. 2020

Oxidative Medicine and Cellular Longevity

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An easy scoring system to predict the risk of poor outcome after mechanical thrombectomy among the elderly is currently not available. Therefore, we aimed to develop a nomogram for predicting the probability of negative prognosis in aged patients with acute ischemic stroke undergoing thrombectomy. In addition, we sought to investigate the association between histological thrombus composition and stroke characteristics. To this end, we prospectively studied a developed cohort using data collected from a stroke center from November 2015 to December 2019. The main outcome was functional independence, defined as a modified Rankin Scale score ≤ 2 at 90 days following a mechanical thrombectomy. A nomogram model based on multivariate logistic models was generated. The retrieved thrombi were stained with hematoxylin and eosin and assessed according to histological composition. Our results demonstrated that age ≥ 72 years was independently associated with poor outcome. A total of 304 participants completed the follow-up data to generate the nomogram model. After multivariate logistic regression, five variables remained independent predictors of outcome, including older age, hemorrhagic transformation, thrombolysis in cerebral infarction score, National Institute of Health Stroke score, and neutrophil-to-lymphocyte ratio, and were used to generate the nomogram. The area under the receiver-operating characteristic curve of the model was 0.803. The clots from elderly subjects with large-artery atherosclerosis, anterior circulation, and successful recanalization groups had a higher percentage of fibrin compared to those of younger patients. This is the first nomogram to be developed and validated in a stroke center cohort for individualized prediction of poor outcome in elderly patients after mechanical thrombectomy. Clot composition provides valuable information on the underlying pathogenesis of oxidation in older patients.

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“… 6 In addition, this patient population became disabled after stroke more often than the younger population. 7 Elderly patients will soon represent the majority of BAO victims, resulting in a substantial impact on health services in the near future. 8 While interventional therapy for elderly patients with acute BAO was currently not considered the standard of care, it was offered at many comprehensive stroke centers or tertiary hospitals in China.…”

Section: Introductionmentioning

confidence: 99%

Endovascular intervention for basilar artery occlusion in the elderly

Luo

Huang²,

Zhang³

et al. 2021

Ther Adv Neurol Disord

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Background: To date, few data have been reported on clinical outcomes following interventions in elderly populations with acute basilar artery occlusion. Using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study (BASILAR), we evaluated the efficacy and safety of intervention and determined predictors of outcomes among elderly patients in China. Methods: Patients from January 2014 to May 2019 were dichotomized into elderly (75 years or older) and nonelderly patients (under 75 years). Pearson’s Chi-square test and multivariate logistic regression were performed to assess 90-day favorable functional outcome (defined as a modified Rankin scale score of 0–3), mortality and symptomatic intracranial hemorrhage between intervention and conservative cohorts in elderly patients. Results: Among the 829 patients in the BASILAR, 182 patients aged 75 years or older were analyzed. These patients were divided into intervention (127 patients) and conservative (55 patients) cohorts. Compared with the conservative cohort, the intervention cohort presented more frequently with a favorable functional outcome (28.3% versus 12.7%; p = 0.023) and with a decreased mortality (54.3% versus 76.4%; p = 0.005). There was no difference in symptomatic intracranial hemorrhage (4.7% versus 0, p = 0.235). Multivariate analysis indicated that intervention was associated with favorable functional outcome (adjusted odds ratio, 0.262; 95% confidence interval, 0.088–0.778, p = 0.016) and lower mortality (adjusted odds ratio, 0.257; 95% confidence interval, 0.109–0.606, p = 0.002). In the intervention cohort, initial National Institutes of Health Stroke Scale (NIHSS) score and occlusion site were associated with functional outcome, and initial NIHSS score and recanalization were associated with mortality. Conclusions: Although the overall outcome following intervention was worse with age, intervention was more effective and safer than conservative treatment for elderly Chinese patients with basilar artery occlusion. Predictors of desirable outcome in elderly patients undergoing intervention included lower initial NIHSS score, occlusion site and successful recanalization. Clinical Trial Registration-URL: http://www.chictr.org . Unique identifier: ChiCTR-1800014759

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Endovascular Treatment of Anterior Circulation Large Vessel Occlusion in the Elderly

Cited by 23 publications

References 46 publications

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience

Nomogram to Predict Poor Outcome after Mechanical Thrombectomy at Older Age and Histological Analysis of Thrombus Composition

Endovascular intervention for basilar artery occlusion in the elderly

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