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Ischemic Stroke
Original research
An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulation acute ischemic stroke: outcomes with respect to age
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  1. Michael Martini1,
  2. J Mocco1,
  3. Aquilla Turk2,
  4. Adnan H Siddiqui3,
  5. David Fiorella4,5,
  6. Ricardo Hanel6,
  7. Keith Woodward7,
  8. Ansaar Rai8,
  9. Don Frei9,
  10. Josser E Delgado Almandoz10,
  11. Michael E Kelly11,
  12. Lissa Peeling11,
  13. Adam S Arthur12,
  14. Blaise Baxter13,
  15. Joey English14,
  16. Italo Linfante15,
  17. Reade De Leacy1
  1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Department of Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
  3. 3 Departments of Neurosurgery and Radiology and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  5. 5 Radiology, Stony Brook School of Medicine, Stony Brook, New York, USA
  6. 6 Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  7. 7 Radiology, Fort Sanders Regional Medical Center, Knoxville, Tennessee, USA
  8. 8 Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
  9. 9 Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  10. 10 Department of Interventional Neuroradiology, Abbot Northwestern Hospital, Minneapolis, Minnesota, USA
  11. 11 Department of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  12. 12 UT Dept Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
  13. 13 Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
  14. 14 Departments of Neurology and Radiology, UCSF, San Francisco, California, USA
  15. 15 Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  1. Correspondence to Dr. Reade De Leacy; reade.deleacy{at}mountsinai.org

Abstract

Background Thrombectomy is an efficacious treatment for acute ischemic stroke (AIS). However, relatively few studies to date have specifically examined the impact and clinical implications of age on outcomes for thrombectomy in anterior AIS.

Objective To provide a snapshot of patient metrics and outcomes with respect to age following thrombectomy for anterior AIS to supplement the current body of data for predictors of clinical outcomes in a real-world setting.

Methods Data were collected for 20 consecutive patients with AIS treated with thrombectomy at 15 high-volume stroke centers across North America between 2015 and 2016. Patients with anterior occlusions were dichotomized based on whether they were older or younger than 80 years. Ordinal logistic regression analyzed how clinical variables impacted disability using 90-day modified Rankin Scale (mRS) scores.

Results Adequate revascularization (TICI ≥2B) was achieved in 92.3% of patients aged <80 years with an average 1.7±0.1 passes taken with the primary technique and in 88.0% of patients aged ≥80 years with an average 1.7±0.2 passes. Despite similar baseline characteristics, mRS scores were significantly higher in older patients postoperatively and at 90 days after intervention. Age was a significant predictor of 90-day mRS across the study population.

Conclusion This analysis affirms age is a significant determinant of 90-day mRS scores following thrombectomy for large vessel anterior AIS. Further investigation into risks faced by elderly patients during thrombectomy may provide actionable information to help refine patient selection and improve outcomes.

  • ischemic stroke
  • age
  • mechanical thrombectomy
  • stent-retriever
  • direct aspiration
  • revascularization

https://doi.org/10.1136/neurintsurg-2019-015093

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    Footnotes

    • Contributors All authors have made a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data; drafted the work or revised it for significant intellectual content; approved the final version of the manuscript; and agree to be accountable for all aspects of the work, including its accuracy and integrity.

    • 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 AHS: Financial Interest/Investor/Stock Options/Ownership: Imperative Care, Q’Apel Medical; Consultant/Advisory Board: Cerenovus, Imperative Care, Medtronic, MicroVention, Penumbra, Q’Apel Medical, Stryker. JE: Consultant: Stryker Neurovascular, Medtronic. AT: Consultant: BALT/Blockade, Cerenovus, Medtronic, Microvention-Terumo, Penumbra, Imperative Care, Stryker. KW: Consultant: Cerenovus, Medtronic, Microvention, Penumbra, Stryker. AR: Consultant: Stryker, Cerenovus, Microvention. BB: Consultant: Penumbra, Medtronic, Stryker; Shareholder: Penumbra. RH: Grant/Research Support: Medtronic, Stryker, Microvention; Consultant: Medtronic, Stryker, Cerenovus, Microvention, Balt. JEDA: Consultant: Penumbra, Medtronic, Microvention. ASA: Consultant: Cerenovus, Medtronic, Microvention, Penumbra, Stryker; Research Support: Microvention, Cerenovus, Penumbra. DFi: Consultant: Medtronic, Microvention, Penumbra, Balt, Cerenovus, Stryker; Research Support: Siemens, Microvention, Penumbra, Cerenovus. MK: Consultant: Penumbra, Medtronic. LP: Consultant: Medtronic. DFr: Consultant/Speakers Bureau: Penumbra, Stryker, Research support: Cerenovus, Medtronic, Microvention, Penumbra, Stryker; Stock ownership: Penumbra. IL: Consultant: Medtronic, Stryker, Cerenovus. RDL: Consultant: Cerenovus, Penumbra, Q’Apel Medical, Imperative Care, Mivi Neuroscience; Research support: Medtronic, Asahi Intec. JM: Consultant: Cerebrotech, Rebound Therapeutics, TSP, Lazarus Effect, Medina, Pulsar Vascular; Investor: Blockade, Medina, Lazarus Effect, TSP; Research support: Penumbra.

    • Ethics approval Approval was obtained from the Institutional Review Boards of Mount Sinai, Medical University of South Carolina, State University of New York at Buffalo, Stony Brook School of Medicine, Lyerly Baptist Medical Center, Fort Sanders Regional Medical Center, West Virginia University Hospitals, Swedish Medical Center, Abbott Northwestern Hospital, University of Saskatchewan College of Medicine, University of Tennessee Health Sciences Center and Semmes Murphey Clinic, Erlanger Health System, California Pacific Medical Center, and Miami Cardiac and Vascular Institute.

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

    • Patient consent for publication Not required.