Endovascular Therapy for Acute Stroke in the Elderly: A Comparison of Outcomes in Patients Above and Below 80 Years

Jeremiah Nicholas Johnson, MD1, Mohamed Elhammady, MD1, Ramsey Ashour, MD1, Anupama Kathiresan, MD1, Dileep Yavagal, MD1, Mohammad Aziz-Sultan, MD1

1Miami, FL United States

Keywords: stroke, thrombolysis, endovascular therapy, outcome, elderly

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Abstract

     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.


Acknowledgements

Project Roles:

J. Johnson (), M. Elhammady (), R. Ashour (), A. Kathiresan (), D. Yavagal (), M. Aziz-Sultan ()