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E-065 differences in clinical, radiological and interventional factors predicting outcome and mortality after mechanical thrombectomy for acute large vessel stroke comparing over and under 70 age groups - a five year retrospective study
  1. S Nayak,
  2. A Sastry,
  3. V Leung,
  4. C Roffe,
  5. T Woo
  1. Neuroradiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom, Newcastle Under Lyme, UK

Abstract

Aim To assess the differences in factors including recanalization time and functional and radiological scoring determining functional outcome and mortality between different age groups after mechanical thrombectomy (MT) for ischemic stroke.

Methods Patients treated between December 2009 and January 2014 (n = 137) for anterior circulation stroke were divided into age groups. Patient data including NIHSS and ASPECT scoring pre and post procedure and procedural timings were collected. Modified Rankin score was used as functional outcome measure at 90 days.

Results For the >70 age group, ASPECTS correlated most strongly with outcome (ASPECTS >7 - OR 3.75, 95% CI 1.04–13.5) and mortality (ASPECTS <8 - OR 5.08, CI 1.1–23.3). In the <70 age group, only NIHSS correlated with both outcome (NIHSS <20 – OR 4.17, CI 1.4–12.2) and mortality (NIHSS >20 – OR 6.22, CI 1.4–26.7) (p < 0.05). Both NIHSS and ASPECTS done at 24 h were strongly associated with outcome at 90 days. Revascularization >5 h after onset in the <70 age group was associated with markedly poorer outcome with increased risk of malignant MCA transformation, while this trend was not seen in the >70 age group.

Conclusions ASPECT scoring at admission is clinically helpful in patient selection for thrombectomy in the >70 age group as it correlates well with outcome and mortality, but less useful in the  <70 age group, possibly due to the increased plasticity of remodeling. Revascularization time appears to be much more important in the younger age group, and restoration of circulation within 5 h should be the goal to reduce the risk of reperfusion injury.

Disclosures S. Nayak: None. A. Sastry: None. V. Leung: None. C. Roffe: None. T. Woo: None.

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