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  • Association between age and outcomes following thrombectomy for anterior circulation emergent large vessel occlusion is determined by degree of recanalisation

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Ischemic Stroke
Original research
Association between age and outcomes following thrombectomy for anterior circulation emergent large vessel occlusion is determined by degree of recanalisation
  1. Mahesh V Jayaraman1,2,3,4,
  2. Thomas Kishkovich1,
  3. Grayson L Baird1,5,
  4. Morgan L Hemendinger3,
  5. Eric L Tung1,
  6. Shadi Yaghi2,3,
  7. Shawna Cutting2,3,
  8. Ali Saad2,3,
  9. Tina M Burton2,3,
  10. Brian Mac Grory2,3,
  11. Richard A Haas1,2,4,
  12. Karen L Furie2,3,
  13. Ryan A McTaggart1,2,3,4
  1. 1 Department of Diagnostic Imaging, Warren Alpert School of Medical at Brown University, Providence, Rhode Island, USA
  2. 2 Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island, USA
  3. 3 Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  4. 4 Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  5. 5 Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island, USA
  1. Correspondence to Dr Mahesh V Jayaraman, Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI 02903, USA; MJayaraman{at}Lifespan.org

Abstract

Background Older patients undergoing thrombectomy for emergent large vessel occlusion have worse outcomes. However, complete or near-complete reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2 c/3) is associated with improved outcomes compared with partial recanalisation (mTICI 2b).

Objective To examine the relationship between outcomes and age separately for the mTICI 2c/3, 2b and 0-2a groups in patients undergoing thrombectomy for anterior circulation emergent large vessel occlusion.

Methods Retrospective review of 157 consecutive patients undergoing thrombectomy at a single centre with an occlusion of the internal carotid artery (ICA), M1 or proximal M2 segments of the middle cerebral artery (MCA). Angiograms were graded in a blinded fashion. Patients were divided into three groups: mTICI 0-2a, mTICI 2b, and mTICI 2c/3. Demographics and workflow parameters were compared. Outcomes at 90 days were compared as a function of age, using both the conventional modified Rankin scale (mRs) and utility weighted mRs (UWmRs).

Results There were 72, 61 and 24 patients in the mTICI 2c/3, 2b and 0-2a groups, respectively. Outcomes were significantly worse with increasing age for the mTICI 2b group, but not for the mTICI 0-2a and 2c/3 groups (P=0.0002). With increasing age, outcomes of the mTICI 2b group approached those of the mTICI 0-2a group. However, outcomes of the mTICI 2c/3 groups were similar for all ages. This association was present for both the original mRs and UWmRs.

Conclusion Increasing age was associated with worse outcomes for those with partial (mTICI 2b) recanalisation, not in patients with complete (mTICI 2c/3) recanalisation.

  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2018-013964

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    Footnotes

    • Contributors All authors: made substantial contributions to the design of the analysis, interpretation of data, drafting and critically revising the manuscript as well as final approval for the version published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • 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 None declared.

    • Patient consent Not required.

    • Ethics approval Lifespan Institutional Review Board.

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