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Endovascular mechanical recanalization of acute ischaemic stroke in octogenarians

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Abstract

Background

Multiple studies have shown a clinical benefit of thrombectomy in acute ischaemic stroke, but most of them excluded octogenarians. The purpose of this study was to compare the outcomes between octogenarians and younger patients after thrombectomy.

Materials and methods

One hundred and sixty-six patients with large cerebral artery occlusion and consecutive thrombectomy were evaluated and divided into two patient age groups: younger than 80 years and older than 80 years. We compared recanalization rates, complications experienced, disability, death after discharge and at a 90-day follow-up between these age groups.

Results

Sixty-eight percent of octogenarians and 72 % of younger patients were registered with successful recanalization (p = 1.0). There was no significant difference in symptomatic intracerebral haemorrhage between the groups (p = 0.32). However, octogenarians had a significantly lower rate of good clinical outcome (24 % vs. 48 %; p = 0.008) and a higher mortality rate (36 % vs. 12 %; p = 0.0013).

Conclusion

Octogenarians have a lower chance of good clinical outcome and a higher mortality rate despite successful recanalization. Nevertheless, 24 % of octogenarians were documented with mRS ≤2. As this age group of octogenarians will grow prospectively, careful patient selection should be mandatory when considering octogenarians for thrombectomy.

Key Points

• Careful patient selection for thrombectomy should be mandatory in octogenarians.

• Octogenarians have a higher mortality rate despite successful recanalization.

• Nearly one-third of octogenarians were documented with a good clinical outcome.

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Abbreviations

BA:

Basilar artery

CT:

Computed tomography

CTA:

Computed tomography angiogram

DWI:

Diffusion weighted sequences

ECASS III:

European Cooperative Acute Stroke Study III

EMA:

European Medicines Agency

IAT:

Intra-arterial thrombolysis

ICA:

Internal carotid artery

ICH:

Intracerebral haemorrhage

IVT:

Intravenous thrombolysis

MCA:

Middle cerebral artery

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Scale

rtPA:

Recombinant tissue plasminogen activator

SITS-MOST:

Safe Implementation of Thrombolysis in Stroke-Monitoring Study

TICI:

Thrombolysis in cerebral infarction

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Acknowledgments

Monika Killer is the scientific guarantor of our publication. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because of the retrospective nature of the analysis. Written informed consent was not required for this study because it was a retrospective analysis. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Neuroradiology, Paracelsus Medical University Salzburg, Salzburg, Austria

    Erasmia Broussalis & F. Weymayr

  2. Research Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria

    Erasmia Broussalis & M. Killer

  3. Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria

    Erasmia Broussalis, E. Trinka & M. Killer

  4. Research Office, Paracelsus Medical University Salzburg, Salzburg, Austria

    W. Hitzl

  5. Department of Neuroanesthesiology, Paracelsus Medical University Salzburg, Salzburg, Austria

    A. F. Unterrainer

  6. Department of Neuroradiology and Neurorology, Research Institute for Neurointervention, Paracelsus Medical University Salzburg, Ignaz-Harrerstrasse 79, 5020, Salzburg, Austria

    Erasmia Broussalis

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  1. Erasmia Broussalis
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  2. F. Weymayr
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  5. E. Trinka
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Correspondence to Erasmia Broussalis.

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Broussalis, E., Weymayr, F., Hitzl, W. et al. Endovascular mechanical recanalization of acute ischaemic stroke in octogenarians. Eur Radiol 26, 1742–1750 (2016). https://doi.org/10.1007/s00330-015-3969-8

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