Article Text

PDF
O-006 Advanced Age Remains a Strong Independent Predictor of Neurologic Outcome Despite Core Infarct Imaging for Patient Selection
  1. D Heck,
  2. M Brown
  1. Radiology, Forsyth Medical Center, Winston Salem, NC

Abstract

Abstract Body Age is a consistent independent predictor of outcome in ischaemic stroke trials. From January 2011 until December of 2012, 85 patients at our institution underwent ischaemic stroke intervention in the anterior circulation in a community based practice at a hospital currently designated as a Comprehensive Stroke Center. All patients were prospectively entered into our ischaemic stroke intervention database. Patients were selected for intervention based on non-invasive imaging confirmation of a large vessel occlusion (LVO) and core infarct imaging, mostly with MRI, and in some cases with CTA/Aspects score. Most patients were treated with mechanical intervention. In 2011, patients were treated preferentially with general anaesthesia, but in 2012 local anaesthesia became the preference. All patients were admitted to a neuroscience intensive care unit staffed by fellowship-trained neurointensivists and received inpatient or outpatient rehabilitation as deemed appropriate. Ninety day MRS was determined on 84 of 85 patients by a practitioner certified in the MRS, with one patient lost to follow-up. The overall mortality at 90 days was 32%. The mortality in patients younger than 75 (n=47) was lower than those 75 or older (n=37) (27% vs 44%). Symptomatic haemmorhagic stroke conversion occurred in 4 patients (5%), 3 over the age of 80 and one 57 year old, and was fatal in all. Good neurologic outcome (MRS 0–2) was obtained in 42% of patients overall, 51% of the younger patients compared with just 29% of the older patients. The baseline NIHSS was just one point lower in the younger group (Mean 16.5 and 17.5, Median 17 and 18, respectively). Revascularisation rates in the younger group were not superior to the older group (TICI 2B or higher 77% and 81%, respectively). There was also no difference in utilisation of general anaesthesia (58% in the younger group and 54% in the older group). In summary, despite the use of advanced imaging to select patients for interventional stroke management, and similar revascularisation rates amongst older and younger patients, age remains a very strong predictor of neurologic outcome. Patients 75 and older had a much higher mortality at 90 days and were much less likely to have a favourable neurologic outcome. These differences may be multifactorial. It is of course possible that an absolute improvement in outcome from stroke intervention can be maintained across the age spectrum, despite overall less favourable outcomes in older patients. Future randomised trials might consider lower age limits than historically utilised to maximise the chance of demonstrating improved outcomes with interventional stroke management.

Disclosures D. Heck: None. M. Brown: None.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.