Predictors of 30-day mortality after endovascular thrombectomy for large vessel occlusion in the elderly

Abstract

Objectives Elderly acute ischemic stroke (AIS) patients (≥80 years) would have dismal clinical outcomes even after successful endovascular revascularization for large vessel occlusion (LVO) in the anterior circulation. We aimed to identify predictors of 30-day mortality after endovascular thrombectomy (EVT) in the elderly. Materials and Methods We included older patients who underwent EVT for AIS due to LVO within 6 h after stroke onset in the anterior circulation between 2017 and 2019. Patients due to posterior circulation stroke, with intracerebral hemorrhage (ICH) or pre-stroke modified Rankin Scale (mRS) score of 4 and 5 were excluded. The primary outcome was mortality within 30 days of EVT. The association between clinical, imaging, procedural, follow-up imaging and mortality were analyzed. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3. Possible predictors of 30-day mortality were assessed by univariate and multivariable logistic regression. Results Total 238 AIS patients eligible for EVT were identified with 58 patients aged 80 years or more. 48 patients met inclusion criteria. Median age was 86 years (age range, 82–102 years). Successful reperfusion was achieved in 38 (79.2%) patients. The 30-day and 90-day mortality rate were 25% and 33.3%, respectively. The independent predictors of 30-day mortality were collateral scores <3 on mCTA (adjusted OR, 16.571; 95% CI, 1.041–263.868; p = 0.047) and number of passes (adjusted OR, 2.475; 95% CI, 1.047–5.847; p = 0.039). Conclusions Lower collateral scores on mCTA and higher number of passes in thrombectomy were independently predictive of 30-day mortality in the elderly.

Safety and outcomes of different endovascular treatment techniques for anterior circulation ischaemic stroke in the elderly: data from the Imperial College Thrombectomy Registry

“…The authors found that the type of technique for thrombectomy was not associated with an increased likelihood of death at 30 days post stroke. Our results are in line with the study of Lai et al as we showed that the type of thrombectomy technique is not associated with risk of death after EVT [ 11 ]. However, in our sample of 105 patients aged 80 years or older we investigated not only the predictors of 90-day mortality, but also those of functional independence at 3 months, successful reperfusion (mTICI ≥ 2b) and haemorrhagic transformation.…”

National Institutes of Health Stroke Scale Score Less Than 10 at 24 hours After Stroke Onset Is a Strong Predictor of a Favorable Outcome After Mechanical Thrombectomy

“…Sixth, mean platelet volume/platelet count ratio in patients with large-artery atherosclerosis also is reported to be associated with patient outcome, 34 but unfortunately the SKIP study did not have such data. Seventh, collaterals were also reported to be related to be associated with patient outcome 35,36 but were not fully examined in this study.…”

Efficacy of Endovascular Thrombectomy in the Oldest Old (Stroke 90+ Study): A Community Center Experience

“…Among patients with available follow-up data, mortality rates were 26% and 33% at 30-days and 90-days post DC, respectively. Some published studies report mortality rate ranging from 31 to 37% for patients who are 80 years and older with EVT [11][12][13] although this rate is higher than those for younger patients. McDonough et al compared mortality rate for patients >=85 years old demonstrating better mortality rate of 31% with EVT compared to 54.3% for those received standard of care [11].…”