Interventional Stroke Therapies in the Elderly: Are We Helping?

Zeevi, Neer; Kuchel, George A.; Lee, N. S.; Staff, Ilene; McCullough, Louise D.

doi:10.3174/ajnr.a2845

Cited by 20 publications

(15 citation statements)

References 39 publications

(48 reference statements)

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“…In that study, however, there were considerable sample asymmetries—with a preponderance of carotid-T occlusions in older (12/22), but not in younger patients (29/87), and a ∼30 min longer average symptom onset to recanalization time in the older subgroup—which may explain the observed differences in postinterventional NIHSS scores. In contrast, several other studies found no age dependency of—sometimes only imprecisely defined—postinterventional neurological improvement after IV rtPA5 and/or various modes of endovascular therapies,6 7 12 which is corroborated by our data.…”

Section: Discussionsupporting

confidence: 90%

Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy

Kleine

Boeckh‐Behrens

Prothmann

et al. 2015

J NeuroIntervent Surg

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Older patients exhibit a similar early neurological course and responsiveness to mechanical thrombectomy as younger patients, but this is not reflected in mid-term functional outcome scores. This indicates that post-stroke complications and other factors that are not, or only indirectly, related to the brain tissue damage induced by the incident stroke have a dominant role in their poor prognosis.

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Section: Discussionsupporting

confidence: 90%

Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy

Kleine

Boeckh‐Behrens

Prothmann

et al. 2015

J NeuroIntervent Surg

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“…3,5,[11][12][13][14][15] Although patients >80 years of age demonstrated lower rates of good clinical outcome at 90 days, elderly patients achieved similar revascularization rates (TICI≥2b; 69.2% versus 73.1%; P=0.5), but at a slower duration (93.1±114.5 versus 71.7±89.5 minutes; P=0.08) than younger patients. Revascularization rates in several studies examining ET in the elderly ranged from 62% to 87.9%, [3][4][5]11,12,16 which are comparable with the findings from the current study. All but one series found no correlation between age >80 years and the likelihood of revascularization.…”

Section: Discussionsupporting

confidence: 82%

Influence of Age on Clinical and Revascularization Outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry

Castonguay

Zaidat

Novakovic

et al. 2014

Stroke

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Background and Purpose-The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry. Methods-The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into ≤80 and >80 years of age. Results-Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were ≤80 years and 78 were >80 years of age. Mean age in the ≤80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score ≤2 versus 45.4% ≤80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and ≤80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality. Conclusion-Greater

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“…In our study, the overall perioperative stroke rate was lower than the recently published data about EC-IC bypass surgery [5] and the current data about endovascular treatments [13,14,25]. Especially the COSS trial found higher perioperative stroke rates, even though the percentage of bypass patency is similar to our results.…”

Section: Discussioncontrasting

confidence: 56%

“…More detailed data on age-dependency is given in nonsurgical, endovascular studies of carotid endarterectomy and stenting. Recent studies showed a significantly increased in-hospital mortality [13] and more adverse events [14,15] after endovascular treatment in older patients. A randomized controlled trial comparing stenting versus endarterectomy for treatment of carotid-artery stenosis revealed a relationship between age and treatment efficacy with a crossover at an age of approximately 70 years [16].…”

Section: Introductionmentioning

confidence: 99%

Extra-Intracranial Standard Bypass in the Elderly: Perioperative Risk, Bypass Patency and Outcome

Sandow¹,

Weitzel-Mudersbach

Rosenbaum

et al. 2013

Cerebrovasc Dis

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Background: Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years. Methods: 50 patients underwent EC-IC standard bypass surgery with translocation of the superficial temporal artery to an M2 segment of the medial cerebral artery. Criteria for bypass surgery were presence of symptomatic occlusive cerebrovascular disease of the anterior circulation and proof of a severely restricted or abrogated reserve capacity (detected by H₂O-photon emission tomography or single photon emission computer tomography - before and after forced vessel dilatation by diamox). The incidence of perioperative neurological and surgical complications, bypass patency, bypass function and short-term outcome were retrospectively analyzed. Results: The study cohort consisted of 16 patients ≥70 years (mean = 74.3 years, SE 1.3). It was compared to a cohort of 34 patients <70 years (mean = 61.2 years, SE 1.0). Both groups underwent EC-IC bypass surgery after careful preoperative work-up. Both patient groups did not differ significantly in gender, vascular pathology, previous history of diseases/comorbidity or clinical symptoms. The number of patients which underwent stenting or other endovascular treatments of the internal or common carotid artery prior to EC-IC bypass surgery was significantly higher in the group of patients ≥70 years (37.5 vs. 0%, p < 0.001). Perioperative stroke rate was 0% in both groups and mild morbidity occurred in 18.8 and 14.7%, respectively (p = 0.699). One 84-year-old female patient died due to perioperative endocarditis. Initial bypass patency was 93.8% in patients above the age of 70 years and 97.1% in the younger group (p = 0.542). Secondary occlusion rate was low in both groups (≥70 years: 0% vs. <70 years 3.7%). No new neurologic deficit occurred in patients with a patent bypass during the follow-up period (median 18 ± 13.1 months). Two patients with an initially occluded bypass and one with a secondary bypass occlusion suffered from new neurological symptoms. Conclusions: Our data show comparable safety and efficiency of EC-IC bypass surgery in patients under and above the age of 70 years due to a careful preoperative work-up and a strict indication for bypass surgery.

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Interventional Stroke Therapies in the Elderly: Are We Helping?

Abstract: BACKGROUND AND PURPOSE:It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed.

Cited by 20 publications

References 39 publications

Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy

Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy

Influence of Age on Clinical and Revascularization Outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry

Extra-Intracranial Standard Bypass in the Elderly: Perioperative Risk, Bypass Patency and Outcome

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