Matthias Barral1, Louis Lassalle2, Cyril Dargazanli3, Mikael Mazighi4, Hocine Redjem3, Raphael Blanc3, Georges Rodesch5, Bertrand Lapergue6, Michel Piotin3. 1. Department of Interventional Neuroradiology, Rothschild Foundation, 25 rue Manin, 75940 Paris, France. Electronic address: Matthias_barral@yahoo.fr. 2. Department of Radiology, Hopital Antoine Beclere, 157 Rue de la Porte de Trivaux, 92140 Clamart, France. 3. Department of Interventional Neuroradiology, Rothschild Foundation, 25 rue Manin, 75940 Paris, France. 4. Department of Interventional Neuroradiology, Rothschild Foundation, 25 rue Manin, 75940 Paris, France; Laboratory of Vascular Translational Science, INSERM U 1148, CHU Bichat, Bâtiment Inserm 46, rue Henri Huchard, 75877 Paris Cedex 18, France. 5. Department of Diagnostic and Interventional Neuroradiology, Hopital Foch, 40, Rue Worth, 92150 Suresnes, France. 6. Division of Neurology, Stroke Center, Hopital Foch, 40, Rue Worth, 92150 Suresnes, France.
Abstract
INTRODUCTION: Mechanical thrombectomy for anterior circulation large vessel occlusion (LVO) improves functional outcome at three months. This therapeutic approach is the new gold standard, with a benefit being also observed in elderly patients. However, data are limited in this heterogeneous and fragile population. The objectives of this study were, first, to describe outcome after mechanical thrombectomy in a representative group of patients over 80. Second, to evaluate factors associated with a favorable functional outcome after thrombectomy for anterior circulation LVO in elderly patients (aged≥80 years). METHODS: A total of 169 patients with anterior circulation LVO referred for an endovascular treatment were included. Primary outcome evaluated functional outcome at three months. Multivariable analysis was performed to identify prognostic factors in elderly patients with pre-stroke mRS≤3. RESULTS: Overall, 25.34% of patients (43/169) were functionally independent at three months (mRS≤2) and 16.57% (28/169) had a moderate functional disability (mRS=3). Mortality rate was 33.14% (56/169). At 24h, 7.1% of patients (12/169) had symptomatic hemorrhage. Male gender (P=0.033), low initial NIHSS (P=0.037), higher DWI-ASPECTS (P=0.022) and use of intravenous thrombolysis (IVT) (P=0.0193) were associated with a better functional outcome. CONCLUSIONS: There is no reason to withhold mechanical thrombectomy on the basis of age alone. Small infarct core, low NIHSS, male gender and use of IVT are associated with a better functional outcome.
INTRODUCTION: Mechanical thrombectomy for anterior circulation large vessel occlusion (LVO) improves functional outcome at three months. This therapeutic approach is the new gold standard, with a benefit being also observed in elderly patients. However, data are limited in this heterogeneous and fragile population. The objectives of this study were, first, to describe outcome after mechanical thrombectomy in a representative group of patients over 80. Second, to evaluate factors associated with a favorable functional outcome after thrombectomy for anterior circulation LVO in elderly patients (aged≥80 years). METHODS: A total of 169 patients with anterior circulation LVO referred for an endovascular treatment were included. Primary outcome evaluated functional outcome at three months. Multivariable analysis was performed to identify prognostic factors in elderly patients with pre-stroke mRS≤3. RESULTS: Overall, 25.34% of patients (43/169) were functionally independent at three months (mRS≤2) and 16.57% (28/169) had a moderate functional disability (mRS=3). Mortality rate was 33.14% (56/169). At 24h, 7.1% of patients (12/169) had symptomatic hemorrhage. Male gender (P=0.033), low initial NIHSS (P=0.037), higher DWI-ASPECTS (P=0.022) and use of intravenous thrombolysis (IVT) (P=0.0193) were associated with a better functional outcome. CONCLUSIONS: There is no reason to withhold mechanical thrombectomy on the basis of age alone. Small infarct core, low NIHSS, male gender and use of IVT are associated with a better functional outcome.