Endovascular Therapy for Acute Stroke in the Elderly: A Comparison of Outcomes in Patients Above and Below 80 YearsKeywords: stroke, thrombolysis, endovascular therapy, outcome, elderlyInteractive Manuscript
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What is the background behind your study?
The incidence of acute ischemic stroke (AIS) increases with age, and the US elderly population is growing rapidly.
What is the purpose of your study?
Endovascular therapy (ET) is a promising new stroke treatment strategy; however, little data exists regarding safety and efficacy in this elderly patient population.
Describe your patient group.
A total of 84 patients met study criteria: 20 patients ?80 (24%) and 64 patients < 80 years old (76%).
Describe what you did.
We retrospectively reviewed all cases of anterior circulation, large vessel occlusion AIS that underwent ET at our institution from 2008 to 2011. Patients were stratified based on age: ? 80 and < 80 years. Prior to ET, all patients had a NIHSS score < 8, underwent a plain CT and a cerebral perfusion study with confirmed significant penumbra.
Describe your main findings.
Patients in the ?80 age group had significantly higher Charleson Comorbidity Index scores (p=0.014). There were no significant differences in initial NIHSS, IV thrombolytics, and time to ET between groups. Successful recanalization (TIMI 2-3) was achieved in 80% and 89.1%, respectively (p=0.243). The ?80 age group had a significantly higher incidence of severe PH 2 hemorrhages (15% vs. 3.1%, p=0.05) than the <80 age group. The ?80 age group had significantly worse Modified Rankin Scale (mRS) scores at discharge (5.0 ± 0.2 vs. 3.5 ± 0.2, p= <0.001), with significantly higher incidence of very poor outcomes (mRS 5-6) (75.0% vs. 26.6%, p<0.001) and 0 patients had a good outcome (mRS 0-2).
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
In carefully selected AIS patients undergoing modern endovascular stroke therapy, elderly patients > 80 had significantly worse functional outcomes.
Describe the importance of your findings and how they can be used by others.
Age is important for predicting outcome.
The incidence of acute ischemic stroke (AIS) increases with age, and the US elderly population is growing rapidly.
Endovascular therapy (ET) is a promising new stroke treatment strategy; however, little data exists regarding safety and efficacy in this elderly patient population.
A total of 84 patients met study criteria: 20 patients ?80 (24%) and 64 patients < 80 years old (76%).
We retrospectively reviewed all cases of anterior circulation, large vessel occlusion AIS that underwent ET at our institution from 2008 to 2011. Patients were stratified based on age: ? 80 and < 80 years. Prior to ET, all patients had a NIHSS score < 8, underwent a plain CT and a cerebral perfusion study with confirmed significant penumbra.
Patients in the ?80 age group had significantly higher Charleson Comorbidity Index scores (p=0.014). There were no significant differences in initial NIHSS, IV thrombolytics, and time to ET between groups. Successful recanalization (TIMI 2-3) was achieved in 80% and 89.1%, respectively (p=0.243). The ?80 age group had a significantly higher incidence of severe PH 2 hemorrhages (15% vs. 3.1%, p=0.05) than the <80 age group. The ?80 age group had significantly worse Modified Rankin Scale (mRS) scores at discharge (5.0 ± 0.2 vs. 3.5 ± 0.2, p= <0.001), with significantly higher incidence of very poor outcomes (mRS 5-6) (75.0% vs. 26.6%, p<0.001) and 0 patients had a good outcome (mRS 0-2).
This is a retrospective study.
In carefully selected AIS patients undergoing modern endovascular stroke therapy, elderly patients > 80 had significantly worse functional outcomes.
Age is important for predicting outcome.
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