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Original research
Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience
  1. Ali Alawieh1,2,
  2. Arindam Chatterjee3,
  3. Wuwei Feng4,
  4. Guilherme Porto2,
  5. Jan Vargas2,
  6. Ryan Kellogg2,
  7. Aquilla S Turk2,
  8. Raymond D Turner2,
  9. M Imran Chaudry2,
  10. Alejandro M Spiotta2
  1. 1 Medical Scientist Training Program, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4 Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Alejandro M Spiotta, Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta{at}musc.edu

Abstract

Introduction Completed randomized trials on endovascular thrombectomy (ET) did not independently assess the efficacy of ET in the elderly (≥80 years old) who were often excluded or under-represented in trials. There were also inconsistent criteria for patient selection in this population across the different trials. This work evaluates outcomes after ET for acute ischemic stroke (AIS) in the elderly at a high volume stroke center.

Methods We reviewed all cases of AIS that underwent a direct aspiration first pass technique (ADAPT) thrombectomy for large vessel occlusions between March 2013 and October 2017 while comparing outcomes in the elderly with younger counterparts. We also reviewed AIS cases in elderly patients undergoing medical management who were matched to the ET counterparts by demographics, comorbidities, baseline deficits, and stroke severity.

Results Of 560 patients undergoing ET for AIS, 108 patients were in the elderly group (≥80 years of age), and had a significantly lower likelihood of functional independence (defined as a modified Rankin Scale score of 0–2) at 90 days compared with younger patients (20.5% vs 44.4%, P<0.001), and higher mortality rates (34.3% vs 20%, P<0.001). When compared with patients undergoing medical management, elderly patients did not have a significant improvement in rates of good outcomes (20.5% vs 19.5%, P>0.05), and had significantly higher rates of hemorrhage (40.7% vs 9.3%, P<0.001). We also identified baseline stroke severity and the incidence of hemorrhage as two independent predictors of outcome in the elderly patients.

Conclusions ET in the elderly did not show a similar benefit to younger patients when compared with medical management. These findings emphasize the need for more optimal selection criteria for the elderly population to improve the risk to benefit ratio of ET.

  • stroke
  • thrombectomy
  • elderly population
  • age

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Footnotes

  • Contributors Each author listed receives authorship credit based on material contribution to this article, their revision of this article, and their final approval of this article for submission to this journal.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AMS: Penumbra–consulting, honorarium, speaker bureau; Pulsar Vascular–consulting, honorarium, speaker bureau; Microvention–consulting, honorarium, speaker bureau, research; Stryker–consulting, honorarium, speaker bureau. AST, RDT, and MIC: Codman–consulting, honorarium, speaker bureau, research funding; Covidien–consulting, honorarium, speaker bureau; Penumbra–consulting, honorarium, speaker bureau, research grants; Microvention–consulting, honorarium, speaker bureau, research grants; Blockade–stock, consulting, honorarium, speaker bureau; Pulsar Vascular–stock, consulting, honorarium, speaker bureau, research; Medtronic–consulting, honorarium, speaker bureau.

  • Patient consent Not required.

  • Ethics approval The study was approved by the institutional review board at the Medical University of South Carolina.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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