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Original research
Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study
  1. Ali Alawieh1,
  2. Robert M Starke2,
  3. Arindam Rano Chatterjee3,
  4. Aquilla Turk1,
  5. Reade De Leacy4,
  6. Ansaar T Rai5,
  7. Kyle Fargen6,
  8. Peter Kan7,
  9. Jasmeet Singh6,
  10. Lukas Vilella6,
  11. Fábio A Nascimento8,
  12. Travis M Dumont9,
  13. David McCarthy2,
  14. Alejandro M Spiotta1
  1. 1Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Neurological Surgery and Neuroradiology, University of Miami, Miami, Florida, USA
  3. 3Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Department of Neurosurgery, Mount Sinai Health System, New York City, New York, USA
  5. 5Radiology, Neurology & Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
  6. 6Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  7. 7Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  8. 8Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
  9. 9Department of Neurosurgery, University of Arizona, Tucson, Arizona, 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

Background The efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial.

Objective To evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared with younger patients.

Methods Data from prospectively maintained databases of patients undergoing ET for AIS at seven US-based comprehensive stroke centers between January 2013 and January 2018 were reviewed. Demographic, procedural, and outcome variables were collected. Outcomes included 90-day modified Rankin Scale (mRS) score, postprocedural National Institutes of Health Stroke Scale score, postprocedural hemorrhage, and mortality. Univariate and multivariate analyses were performed to assess the independent effect of age ≥80 on outcome measures. Subgroup analyses were also performed based on location of stroke, success of recanalization, or ET technique used.

Results Rates of functional independence (mRS score 0–2) after ET in elderly patients were significantly lower than for younger counterparts. Age ≥80 was independently associated with increased mortality and poor outcome. Age ≥80 showed an independent negative prognostic effect on outcome even when patients were divided according to thrombectomy technique, location of stroke, or success of recanalization. Age ≥80 independently predicted higher rate of postprocedural hemorrhage, but not success of recanalization. Baseline deficit and number of reperfusion attempts, but not Thrombolysis in Cerebral Infarction score were associated with lower odds of good outcome.

Conclusion The large effect size of ET on AIS outcomes is significantly diminished in the elderly population when using comparable selection criteria to those used in younger counterparts. This raises concerns about the risk–benefit ratio and the cost-effectiveness of performing this procedure in the elderly before optimizing patient selection.

  • thrombectomy
  • stroke

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Footnotes

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

  • 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 AT: consulting- Codman, Penumbra, Microvention, Blockade, Pulsar Vascular, Medtronic, Siemens; research grants- Codman, Penumbra, Microvention, Pulsar Vascular, Medtronic; Stock- Pulsar Vascular, Blockade. PK– consultant, Medtronic and Stryker neurovascular. AMS: consulting- Penumbra, Pulsar Vascular, Microvention, Stryker; honorarium- Penumbra, Pulsar Vascular, Microvention, Stryker; speaker bureau- Penumbra, Pulsar Vascular, Microvention, Stryker; research- Microvention.

  • Patient consent Not required.

  • Ethics approval MUSC IRB.

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

  • Correction notice Since this paper was first published online the author Fábio Nascimento has been updated to Fábio A Nascimento.

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