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

Alawieh, Ali; Chatterjee, Arindam; Feng, Wuwei; Porto, Guilherme; Vargas, Jan; Kellogg, Ryan T; Turk, Aquilla S; Turner, Raymond D; Chaudry, M Imran; Spiotta, Alejandro M

doi:10.1136/neurintsurg-2018-013787

Cited by 63 publications

(44 citation statements)

References 31 publications

(10 reference statements)

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“…According to the German Stroke Registry [4] 28.5% patients died and 36.7% had good functional outcomes after ET in the carotid artery system after 90 days, which is close to our data. The outcomes differ from the results of randomized trials in other publications as well [5] and in a senior age group in particular [6]. When comparing ET outcomes in the vertebrobasilar system with those provided in the German registry [3], there are substantial differences: 30.9% patients died after 90 days (in this study this figure was 52.9% at discharge) and 37.7% had good functional outcomes (in this study 24.3% at discharge).…”

contrasting

confidence: 76%

How to Set up a Thrombectomy Service

et al. 2020

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contrasting

confidence: 76%

How to Set up a Thrombectomy Service

et al. 2020

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“…In addition, the rates of successful recanalization were found lower in patients aged ≥80 years compared with those in patients aged <80. Potential explanations for the worse functional outcome and higher rates of mortality in elderly patients treated with MT are as follows: first, the age itself was a negative independent factor for prognosis; the neurological reserve and neuroplasticity in brain tissues were decreased with age, which could delay the recovery of patients (11,30,31); Second, elderly patients are usually accompanied by higher rates of in-hospital complications, such as intracerebral hemorrhage and other diseases in old age (14,16,19,32). Finally, successful recanalization was an influential factor for achieving favorable function outcome, particularly in elderly patients (21).…”

Section: Discussionmentioning

confidence: 99%

“…A total of 1,810 relevant studies were initially identified through literature retrieval, and 16 studies were finally included in this meta-analysis after screening (12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). A flow diagram of the detailed search process was present in Supplemental Figure 1.…”

Section: Literature Search Study Characteristics and Quality Assessmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis

Zhao

Ping

et al. 2020

Front. Neurol.

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Background and purpose: Multiple randomized trials have confirmed that mechanical thrombectomy (MT) is an effective treatment method for patients with acute ischemic stroke (AIS). However, evidence on the safety and efficacy of MT in elderly patients compared with younger patients is controversial. This meta-analysis is aimed to systematically compare the outcomes of elderly patients and younger patients after MT for AIS.Methods: A systematic literature search was conducted through the PubMed, EMBASE, and Cochrane Library database. The primary outcomes were favorable functional outcome at 90 days and mortality. The secondary outcomes were symptomatic intracerebral hemorrhage (sICH) and successful recanalization rate. Odds ratios (ORs) were estimated using a random effects model. Results: Sixteen studies published between 2014 and 2019 were included in this meta-analysis totally involving 3,954 patients. The pooled results showed that patients aged ≥80 years had worse functional outcome (OR = 0.40; 95% CI, 0.32-0.50; P < 0.001) and higher rates of mortality (OR = 2.26; 95% CI, 1.73-2.95; P < 0.001). There was a trend of higher rates of sICH in patients aged ≥80 years compared with patients aged <80 years, whereas this did not reach statistical significance (OR = 1.28; 95% CI, 0.89-1.84; P = 0.18). Furthermore, the frequency of successful recanalization was also lower in patients aged ≥80 years compared with patients aged <80 years (OR = 0.72; 95% CI, 0.55-0.95; P = 0.02). The subgroup analysis indicated that in comparison with those studies published between 2014 and 2016, elderly patients undergoing MT had better outcomes in studies published between 2017 and 2019.Conclusion: Elderly patients undergoing MT had higher risk of mortality and worse functional outcome. Meanwhile, there was a trend toward higher rates of sICH and lower probability of achieving successful recanalization in elderly patients. These findings emphasize the need for improving the rates of successful recanalization in elderly patients Zhao et al.Mechanical Thrombectomy for Ischemic Stroke in Octogenarians with AIS. In addition, advanced technology of endovascular intervention and peri-interventional management might be associated with the prognosis in elderly patients. However, more prospective or randomized studies should be conducted to further explore this issue.

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“…Previous single-institution, retrospective evaluations of elderly patients presenting with acute stroke demonstrated no additional benefit of ET using aspiration at first pass compared with matched controls receiving optimal medical management. Furthermore, the ET group had a higher rate of mortality and hemorrhage 9. In this multicenter expansion of prior work, we selected one of the largest datasets of patient outcomes after level 1 evidence backed ET approaches (aspiration and stent retriever) in ‘real-world’ practice across multiple centers to evaluate thrombectomy outcomes in octogenarians.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

Alawieh

Starke

Chatterjee

et al. 2018

J NeuroIntervent Surg

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BackgroundThe efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial.ObjectiveTo evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared with younger patients.MethodsData from prospectively maintained databases of patients undergoing ET for AIS at seven US-based comprehensive stroke centers between January 2013 and January 2018 were reviewed. Demographic, procedural, and outcome variables were collected. Outcomes included 90-day modified Rankin Scale (mRS) score, postprocedural National Institutes of Health Stroke Scale score, postprocedural hemorrhage, and mortality. Univariate and multivariate analyses were performed to assess the independent effect of age ≥80 on outcome measures. Subgroup analyses were also performed based on location of stroke, success of recanalization, or ET technique used.ResultsRates of functional independence (mRS score 0–2) after ET in elderly patients were significantly lower than for younger counterparts. Age ≥80 was independently associated with increased mortality and poor outcome. Age ≥80 showed an independent negative prognostic effect on outcome even when patients were divided according to thrombectomy technique, location of stroke, or success of recanalization. Age ≥80 independently predicted higher rate of postprocedural hemorrhage, but not success of recanalization. Baseline deficit and number of reperfusion attempts, but not Thrombolysis in Cerebral Infarction score were associated with lower odds of good outcome.ConclusionThe large effect size of ET on AIS outcomes is significantly diminished in the elderly population when using comparable selection criteria to those used in younger counterparts. This raises concerns about the risk–benefit ratio and the cost-effectiveness of performing this procedure in the elderly before optimizing patient selection.

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

Abstract: ET in the elderly did not show a similar benefit to younger patients when compared with medical management. These findings emphasize the need for more optimal selection criteria for the elderly population to improve the risk to benefit ratio of ET.

Cited by 63 publications

References 31 publications

How to Set up a Thrombectomy Service

How to Set up a Thrombectomy Service

Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

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