Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

  • Kim, Dong Hun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sang Uk (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dong Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yi, Ho Jun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.12.23
  • Accepted : 2017.09.30
  • Published : 2017.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

Keywords

References

  1. Auerbach O, Hammond EC, Garfinkel L : Thickening of walls of arterioles and small arteries in relation to age and smoking habits. N Engl J Med 278 : 980-984, 1968 https://doi.org/10.1056/NEJM196805022781803
  2. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015 https://doi.org/10.1056/NEJMoa1411587
  3. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015 https://doi.org/10.1056/NEJMoa1414792
  4. Chandra RV, Leslie-Mazwi TM, Oh DC, Chaudhry ZA, Mehta BP, Rost NS, et al. : Elderly patients are at higher risk for poor outcomes after intra-arterial therapy. Stroke 43 : 2356-2361, 2012 https://doi.org/10.1161/STROKEAHA.112.650713
  5. Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, et al. : Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation 121 : 879-891, 2010 https://doi.org/10.1161/CIRCULATIONAHA.109.892497
  6. Ford GA, Ahmed N, Azevedo E, Grond M, Larrue V, Lindsberg PJ, et al. : Intravenous alteplase for stroke in those older than 80 years old. Stroke 41 : 2568-2574, 2010 https://doi.org/10.1161/STROKEAHA.110.581884
  7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372 : 1019-1030, 2015 https://doi.org/10.1056/NEJMoa1414905
  8. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387 : 1723-1731, 2016 https://doi.org/10.1016/S0140-6736(16)00163-X
  9. Hajdu MA, Heistad DD, Siems JE, Baumbach GL : Effects of aging on mechanics and composition of cerebral arterioles in rats. Circ Res 66 : 1747-1754, 1990 https://doi.org/10.1161/01.RES.66.6.1747
  10. Hong KS, Ko SB, Yu KH, Jung C, Park SQ, Kim BM, et al. : Update of the Korean clinical practice guidelines for endovascular recanalization therapy in patients with acute ischemic stroke. J Stroke 18 : 102-113, 2016 https://doi.org/10.5853/jos.2015.01655
  11. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015 https://doi.org/10.1056/NEJMoa1503780
  12. Kim D, Ford GA, Kidwell CS, Starkman S, Vinuela F, Duckwiler GR, et al. : Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years. AJNR Am J Neuroradiol 28 : 159-163, 2007
  13. Kim JM, Moon J, Ahn SW, Shin HW, Jung KH, Park KY : The etiologies of early neurological deterioration after thrombolysis and risk factors of ischemia progression. J Stroke Cerebrovasc Dis 25 : 383-388, 2016 https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.010
  14. Loh Y, Kim D, Shi ZS, Tateshima S, Vespa PM, Gonzalez NR, et al. : Higher rates of mortality but not morbidity follow intracranial mechanical thrombectomy in the elderly. AJNR Am J Neuroradiol 31 : 1181-1185, 2010 https://doi.org/10.3174/ajnr.A2079
  15. Lund-Johansen P : The hemodynamics of the aging cardiovascular system. J Cardiovasc Pharmacol 12 Suppl 8 : S20-S32, 1988 https://doi.org/10.1097/00005344-198812081-00006
  16. Mazighi M, Labreuche J, Meseguer E, Serfaty JM, Laissy JP, Lavallee PC, et al. : Impact of a combined intravenous/intra-arterial approach in octogenarians. Cerebrovasc Dis 31 : 559-565, 2011 https://doi.org/10.1159/000324626
  17. Mione G, Ducrocq X, Thilly N, Lacour JC, Vespignani H, Richard S : Outcome of intravenous recombinant tissue plasminogen activator for acute ischemic stroke in patients aged over 80 years. Geriatr Gerontol Int 16 : 843-849, 2016 https://doi.org/10.1111/ggi.12565
  18. Mono ML, Romagna L, Jung S, Arnold M, Galimanis A, Fischer U, et al. : Intra-arterial thrombolysis for acute ischemic stroke in octogenarians. Cerebrovasc Dis 33 : 116-122, 2012 https://doi.org/10.1159/000333429
  19. Pego PM, Nunes AP, Ferreira P, Sousa C, Amaral-Silva A : Thrombolysis in patients aged over 80 years is equally effective and safe. J Stroke Cerebrovasc Dis 25 : 1532-1538, 2016 https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.03.007
  20. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. : 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46 : 3020-3035, 2015 https://doi.org/10.1161/STR.0000000000000074
  21. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2285-2295, 2015 https://doi.org/10.1056/NEJMoa1415061
  22. Tanne D, Gorman MJ, Bates VE, Kasner SE, Scott P, Verro P, et al. : Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older : the tPA stroke survey experience. Stroke 31 : 370-375, 2000 https://doi.org/10.1161/01.STR.31.2.370
  23. The Statistics Korea : Annual report on the cause of death statistics. Available from : http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board? bmode=read&bSeq=&aSeq=348539&pageNo=2&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=%EC%82%AC%EB%A7%9D
  24. The Statistics Korea : Population and housing census. Available from : http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1IN0001_ENG&conn_path=

Cited by

  1. Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience vol.10, pp.12, 2018, https://doi.org/10.1136/neurintsurg-2018-013787
  2. Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study vol.11, pp.6, 2019, https://doi.org/10.1136/neurintsurg-2018-014289
  3. Using machine learning to optimize selection of elderly patients for endovascular thrombectomy vol.11, pp.8, 2019, https://doi.org/10.1136/neurintsurg-2018-014381
  4. Predictors of discharge outcomes following percutaneous mechanical thrombectomy in patients with acute ischemic stroke: Comparisons between the home discharge group and hospital transfer group vol.33, pp.1, 2017, https://doi.org/10.15369/sujms.33.9
  5. Predictors of home discharge after mechanical thrombectomy in patients with acute ischemic stroke: Usefulness of National Institutes of Health Stroke Scale sub-items assessed 24 h postoperatively vol.26, pp.None, 2017, https://doi.org/10.1016/j.inat.2021.101341