Abstract
Abstract only
Background:
Age is a strong predictor of outcomes following acute ischemic stroke (AIS). Conflicting data exist on whether endovascular reperfusion therapy (ERT) should be offered to patients over 80 years of age. We compared the safety and efficacy of ERT in elderly (> 80 years) compared to non-elderly (< 80 years) patients with AIS.
Methods:
We collected data from a large multi-center prospective registry of AIS patients treated with ERT. Data were available on demographics, initial severity, angiographic results, hemorrhagic complications using the ECASS criteria, and 3-month functional outcomes using the modified Rankin Scale (mRS). The thrombolysis in myocardial infarction (TIMI) score was used to grade reperfusion. We compared baseline factors, procedural results, and clinical outcomes in those over > 80 years versus those < 80 years. P-value < 0.05 was considered significant.
Results:
Among 1077 patients with anterior circulation AIS, 223 (20.7%) were > 80 years. Elderly patients were more likely to have atrial fibrillation (54.3% vs. 31.4%, P < 0.001) but less likely to have diabetes (16.1% vs. 24.6%; P=0.046) or smoking (13.2% vs. 32.6%, P<0.001) history. Both groups were similar in other baseline factors, initial NIHSS score, location of occlusions, time from onset to groin puncture. TIMI 2 or 3 reperfusion was achieved in 64.5% of those > 80 vs. 70.7% in those < 80 (P=0.080). Rates of symptomatic hemorrhage and any intracranial hemorrhage were not different between groups. Good outcome at 3 months (mRS 0-2) was noted in 16.5% of elderly compared to 41.5% of non-elderly patients (P<0.001). Amongst elderly patients, the only independent predictor of good outcome was initial NIHSS score (adj. OR 0.882, 95% CI 0.821-0.948); good outcomes were achieved in 32.1% of those with NIHSS score < 10, 16.8% with NIHSS score 11-20, and only 5.9% with NIHSS score > 20.
Conclusions:
Patients > 80 years account for over one-fifth of those treated with ERT in this large registry and had worse outcomes compared with those < 80 years despite similar initial severity, time to treatment, and procedural results. Other factors such as increased baseline disability, more rapid time to completed infarction, and reduced neural plasticity may be contributing to these findings.