Mechanical Thrombectomy in Acute Ischemic Stroke—Patients with Wake-Up Stroke and the Elderly May Benefit as Well

https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.05.019Get rights and content

Background

We have assessed to what extent age, sex, preintervention infarct size, time to groin puncture, and stroke severity are associated with outcome of mechanical thrombectomy in patients treated for acute ischemic stroke.

Methods

All 192 patients treated with mechanical thrombectomy for acute ischemic stroke from September 2005 to December 2011 were included in this observational study. Main outcomes were independence, defined as a modified Rankin Scale score of 0-2, an improvement in stroke severity score post-thrombectomy, and the occurrence of symptomatic hemorrhage. Exposure variables were sex, age, intravenous thrombolysis, prethrombectomy stroke severity grading, pretreatment infarct size, time from onset of symptoms to groin puncture, thrombectomy device used, and the angiographic result from the thrombectomy.

Results

For patients above 50 years with no neurological symptoms before stroke onset, the proportion gaining independence was unrelated to age group, ranging from 49% to 54%. For patients younger than 50 years of age, the proportion was significantly higher (81%). Patients with wake-up stroke did not differ from other patients with regard to outcome.

Conclusions

Our results emphasize that when patients are selected on the basis of angiographic and perfusion imaging, both older patients and patients with wake-up stroke may experience a favorable outcome after mechanical thrombectomy.

Introduction

Mechanical thrombectomy has been shown to be both effective and safe in the treatment of acute ischemic stroke.1, 2, 3, 4, 5 It has been suggested, however, that elderly patients benefit less from the procedure.6 We have previously presented data on the safety and efficiency of mechanical thrombectomy as experienced at the Karolinska University Hospital during the period 2005-2011.7 We have now reassessed our data to address the effects of factors such as age, preintervention Alberta Stroke Program Early CT Score (ASPECTS),8 and National Institutes of Health Stroke Scale (NIHSS) score9 on successful thrombectomy, functional outcome, and symptomatic hemorrhage.

Section snippets

Clinical Setup, Patients, and Technique

Mechanical thrombectomy was initiated at the Karolinska University Hospital in September 2005 and patients were included in the present study from the start through December 2011.

The flow and selection of patients have been presented in detail previously.7 As previously described, the study consists of patients from our own hospital and from mainly 6 other hospitals in the region. Occasionally, patients were transferred from more distant hospitals as well. If there were no contraindications,

Baseline Data

Baseline data for the patients are presented in Table 1.

During the study period, 192 patients with an anterior circulation occlusion were selected for thrombectomy. There were 104 (54.2%) men and 88 (45.8%) women. The mean age was 64.1 years and the median age was 66 years; 44% of the patients were under the age of 65, 46% between 65 and 79, and 9% were 80 years old or above. The median pretreatment NIHSS score was 16 and the median ASPECTS was 8. Eighty-nine patients (46.4%) were treated with

Discussion

In the present study, we found that when patients are selected according to our protocol, functional outcome after mechanical thrombectomy was as good for those over 80 years of age as it was for those between 50 and 65 years of age. In addition, we found no statistically significant associations between time from stroke onset to groin puncture and good outcome or reduction in NIHSS score of 4 or more points, suggesting that using perfusion imaging as a part of this process might help to find

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Conflict of interest: Dr. Andersson consults for Neuravi, Covidien, Rapid Medical, Stryker, and Johnson & Johnson. Dr. Kuntze Söderqvist has given a lecture for Boehringer Ingelheim AB and Dr. Kaijser has given lectures for Roche.

Authors' contributions: Dr. Kuntze Söderqvist has collected most of the data, but also dr Andersson and Dr. Wahlgren have substantially contributed in data collection. Dr. Kuntze Söderqvist and Dr. Kaijser have performed the analysis. Dr. Kuntze Söderqvist has written the draft, and Dr. Kaijser, Dr. Andersson and Dr. Wahlgren have revised it critically and approved on the final version.

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