Patient Selection for Stroke Endovascular Therapy-- DWI-ASPECTS Thresholds Should Vary among Age Groups: Insights from the RECOST Study

Abstract

BACKGROUND AND PURPOSE:The purpose of this study was to evaluate the benefits of endovascular intervention in large-vessel occlusion strokes, depending on age class.

Leukoaraiosis Burden Significantly Modulates the Association Between Infarct Volume and National Institutes of Health Stroke Scale in Ischemic Stroke

“…This is further underscored by the fact that higher age and admission NIHSS predict worse outcomes after endovascular therapy, 30 and-most important to the present study-patients aged >80 years may only benefit from endovascular stroke therapy when their ischemic core volume is lower than that of younger patients. 31 In this respect, our results provide a biologically plausible rationale (1) as to why older patients (who are more likely to have leukoaraiosis) may tolerate only relatively smaller infarcts and (2) that leukoaraiosis may be considered a marker of biological age that could improve on standard chronological age-based inclusion criteria. Nevertheless, given the retrospective nature of our study, results should be considered hypothesis generating only and not guide clinical decision making at this point.…”

TICI and Age: What's the Score?

“…Improved likelihood of good outcome in patients selected using imaging criteria was highlighted by an assessment of stroke therapy scoring grades performed by Marks et al, 28 in which better clinical outcomes were associated with TICI 2b-3 scores compared with TICI 0 -2a and with TIMI 2 or 3 scores only when the patient had a target mismatch, suggesting that good outcome is dependent more on reperfusion than on recanalization. Furthermore, Daniere et al 29 found that despite higher ASPECTSs in the older age groups, they still had significantly poorer outcomes than the younger groups. The authors concluded that the elderly may benefit from thrombectomy when their core volume is small, and they suggested that an age-adjusted ASPECTS should be used to maximize the chance of good clinical outcome postintervention.…”

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

“…60 A smaller study from the same centre on 31 consecutive patients, focusing on basilar artery occlusion treated with Solitaire FR device, found a good correlation between brainstem DWI score <3 and favorable clinical outcome. 40 The prospective, single-arm multicentre DEFUSE-2 trial showed favorable clinical outcomes in patients selected for endovascular treatment with MRI perfusion-weighted imaging (PWI) mismatch in MCA or ICA occlusions (n ¼ 98, about half pre-treated with IVT).…”