Satoshi Koizumi1, Takahiro Ota1, Keigo Shigeta2, Tatsuo Amano3, Masayuki Ueda4, Yuji Matsumaru5, Yoshiaki Shiokawa6, Teruyuki Hirano3. 1. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan. 2. Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Japan. 3. Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan. 4. Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan. 5. Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, Ibaraki, Japan. 6. Department of Neurosurgery, Kyorin University, Mitaka, Japan.
Abstract
BACKGROUND: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. METHODS: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 - ≤180 min; category 2, > 180 - ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. RESULTS: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. CONCLUSIONS: In MT for elderly patients, effective recanalization improved the patients' outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.
BACKGROUND: Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke with large vessel occlusion; however, evidence remains insufficient for MT for elderly patients, especially with respect to factors affecting their outcomes. METHODS: This study was a retrospective analysis of a multicenter registry of MT, called Tama Registry of Acute Endovascular Thrombectomy. Patients were divided by their age into 2 groups: Nonelderly (NE; < 80) and elderly (E; ≥80). Factors related to a good outcome (modified Rankin scale score ≤2) were examined in each group. Onset to reperfusion time (OTR) was stratified into 4 categories: category 1, 0 - ≤180 min; category 2, > 180 - ≤360 min; category 3, > 360 min or onset time not identified; and category 4, effective recanalization not achievable. RESULTS: 143 NE patients and 78 E patients were included in this study. The E group had less chance of achieving a good outcome (NE group 51%, E group 35%; p = 0.024). In the NE group, lower OTR category was an independent prognostic factor for good outcome (p = 0.037, OR = 1.09). However, in the E group, OTR category was not a significant predictor on multivariate analysis. Instead, effective recanalization (p = 0.0081, OR 1.40) and lower National Institute of Health Stroke Scale score at presentation (p = 0.0032, OR 1.02) were the independent predictors. CONCLUSIONS: In MT for elderly patients, effective recanalization improved the patients' outcome but OTR affected less. Further studies are warranted to establish the appropriate patient selection and treatment strategies.