Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke

Clin Neurol Neurosurg. 2014 Aug;123:136-41. doi: 10.1016/j.clineuro.2014.05.025. Epub 2014 Jun 4.

Abstract

Objective: The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (≥80 years) to non-elderly patients (<80 years) who underwent multimodality IAT.

Methods: From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged ≥80 years were compared to the patients <80 years.

Results: Between 2008 and 2012, 24 patients ≥80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p=<0.001) and atrial fibrillation (58.3% vs. 25.2%, p=0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p=0.17), THRIVE score (4.21 vs. 4.39, p=0.633), recanalization rate (70.1% vs. 85.3%, p=0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p=0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p=0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p=<0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7-16.7; p=0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1-2.40; p=0.008) were independently associated with elderly age.

Conclusion: Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.

Keywords: Aged 80 and over; Endovascular procedures; Intra-arterial therapy; Mechanical thrombolysis; Stroke.

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / therapy*
  • Combined Modality Therapy / methods
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Injections, Intra-Arterial* / methods
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Reperfusion
  • Retrospective Studies
  • Stroke / therapy*
  • Tissue Plasminogen Activator / therapeutic use*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator