Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Kawaji, Hiroshi; Tomoto, Kyoichi; Arakawa, Tomoya; Hayashi, Masataka; Ishii, Tatsuhito; Homma, Kazunari; Matsui, Shusuke; Hiramatsu, Hisaya; Ohashi, Toshihiko; Kurozumi, Kazuhiko; Namba, Hiroki

doi:10.2176/nmc.oa.2020-0412

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Ischemic stroke represents a major health concern worldwide. Importantly, due to shifting living and dietary habits, the average age of occurrence of stroke has gradually become younger [ 44 , 45 ]. In terms of the treatment of stroke, intravenous thrombolysis is the most commonly used method, although the effective time window is limited [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Cdh5-mediated Fpn1 deletion exerts neuroprotective effects during the acute phase and inhibitory effects during the recovery phase of ischemic stroke

et al. 2023

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Ischemic stroke is associated with high mortality and morbidity rates worldwide. However, the molecular mechanisms underlying the neuronal damage incurred by stroke victims remain unclear. It has previously been reported that ischemic stroke can induce an increase in the levels of brain iron, which is an important factor of in the associated brain damage. Ferroportin 1 (FPN1), the only known cellular iron export protein, is found in brain microvascular endothelial cells (BMVECs) at the blood-brain barrier, and is considered the gateway for entry of plasma iron into the central nervous system. Despite the connection of brain iron to neuronal damage, the role of BMVECs FPN1 in ischemic stroke remains unexplored. Herein, we conditionally deleted Fpn1 in mouse endothelial cells (ECs), using VE-cadherin-Cre transgenic mice, and explored the impact on brain iron homeostasis after stroke. Our data demonstrated that Fpn1 knockout in ECs decreased the brain iron levels in mice, attenuated the oxidative stress and inflammatory responses after stroke, and inhibited both ferroptosis and apoptosis, ultimately alleviating neurological impairment and decreasing cerebral infarct volume during the acute phase of ischemic stroke. By contrast, we found that Fpn1 knockout in ECs delayed the recovery of neurological function in mice following ischemic stroke. We also found that ECs Fpn1 knockout decreased the brain iron levels after stroke, exacerbated glial cell proliferation, and inhibited neuronal development, indicating that the diminished brain iron levels hindered the repair of neural injury in mice. In conclusion, our findings reveal a dual consequence of FPN1 deficiency in ECs in the development of ischemic stroke. More specifically, iron deficiency initially exerts a neuroprotective effect during the acute phase of ischemic stroke but inhibits recovery during the later stages. Our findings are important to the development of iron- or FPN1-targeting therapeutics for the treatment of ischemic stroke.

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Section: Discussionmentioning

confidence: 99%

Cdh5-mediated Fpn1 deletion exerts neuroprotective effects during the acute phase and inhibitory effects during the recovery phase of ischemic stroke

et al. 2023

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“…11 On the contrary, several studies reported good outcomes in older adult patients after strict screening. 12 Outcomes of EVT among older adults are better than among the older adults received general supportive measures. The lower NIHSS score at the admission, shorter duration of EVT, and better thrombolysis in cerebral infarction (TICI) score could be the predictors of good outcome.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Mechanical Thrombectomy for Anterior Circulation Emergent Large-Vessel Occlusion in the Older Adults

Zhai

Song

et al. 2023

Clin Appl Thromb Hemost

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Few studies have reported the clinical outcomes of older adult patients with acute anterior circulation large-vessel occlusion (LVO) who underwent mechanical thrombectomy (MT). Therefore, we investigated the safety, functional outcomes, and predictors of MT for anterior circulation LVO in older adults. We enrolled patients with acute anterior circulation LVO from May 2018 to October 2021 in this retrospective study. Patients were divided into older (≥80 years) and young (<80 years) groups. Multivariable logistic regression analyses determined the safety, functional outcomes, and predictors of MT for anterior circulation LVO. We divided 1182 patients with acute ischemic stroke into young (18-79 years; 1028 patients) and older (≥80 years; 154 patients) groups. Compared with the young group, the older group had more unfavorable functional outcomes and increased mortality ( P = .003). In the older adult patients, lower initial NIHSS score and higher ASPECTS were correlated with good outcomes. On the contrary, higher initial NIHSS score and lower ASPECTS were related to increased mortality. No difference was detected in symptomatic intracranial hemorrhage within 48 h between two groups. Increasing age was associated with lower rates of favorable functional outcomes and higher mortality rates. The lower initial NIHSS score combined with the higher ASPECTS may predict functional outcomes post-thrombectomy in older adults.

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“…As age is a major risk factor of stroke, and more than 80% of strokes occurring in elderly patients over the age of 65 (9). However, the elderly with AIS were usually excluded from large randomized controlled stroke clinical trials because of their high risk of complication, poor prognosis (7,10), although mechanical thrombectomy (MT) is still recommended as preferred treatment for elderly patients (11).…”

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confidence: 99%

Safety and Efficacy of Mechanical Thrombectomy in Elderly Patients with Acute Ischemic Stroke: A Single-Center Experience

Zheng

et al. 2023

Preprint

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Background Mechanical thrombectomy (MT) has been established as the first-line treatment for acute ischemic stroke (AIS) from large vessel occlusions. However, the benefits of MT to the patients over 80 years old is not yet clear, for the elderly with AIS were usually excluded from large randomized controlled stroke clinical trials for their poor prognosis. Methods This study enrolled 187 adult patients with acute ischemic stroke from large vessel occlusions, including 53 patients ≥ 80 years old. Propensity score matching was used to match the patients༜80 years old with those ≥ 80 years old in a ratio of 1:1. The elderly patients were divided into bridging therapy subgroup and direct MT subgroup. The baseline characteristics and outcome were compared between younger patients and older patients, and elderly patients in two subgroups by multivariate logistic regression analysis. Results The good functional status at 90 days occurred in 44 (32.8%) younger patients, 12 (22.6%) in older patients, but the difference was not statistically significant (adjusted OR, 1.244[95%CI,0.520–2.882], P = 0.644). A higher mortality rate was observed in older patients (43% vs 16%, OR,0.245[95%CI,0.104–0.578], P = 0.001). After propensity score matching, the similar results were found in the good functional prognosis and mortality in the two groups. Moreover, in elderly patients, no significant difference was found in the outcome between the two subgroups. Conclusions Elderly patients with AIS from large vessel occlusions who received MT had similar good functional status and successful reperfusion to patients༜80 years old. MT is effective and relatively safe for the elderly.

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Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Cited by 4 publications

References 27 publications

Cdh5-mediated Fpn1 deletion exerts neuroprotective effects during the acute phase and inhibitory effects during the recovery phase of ischemic stroke

Cdh5-mediated Fpn1 deletion exerts neuroprotective effects during the acute phase and inhibitory effects during the recovery phase of ischemic stroke

Predictors of Mechanical Thrombectomy for Anterior Circulation Emergent Large-Vessel Occlusion in the Older Adults

Safety and Efficacy of Mechanical Thrombectomy in Elderly Patients with Acute Ischemic Stroke: A Single-Center Experience

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