Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores.
Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores.
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DOI：
10.1007/s10072-023-06995-3
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发表时间：
2023-09
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通讯作者：
Qian Liu;Jing-huan Fang;Xin Jiang;Ting Duan;Ya-ping Luo;Lijie Gao;Shuju Dong;M. Ma;Muke Zhou;Li He
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文献类型：
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作者：
Qian Liu;Jing-huan Fang;Xin Jiang;Ting Duan;Ya-ping Luo;Lijie Gao;Shuju Dong;M. Ma;Muke Zhou;Li He
背景了解血管内治疗（EVT）的益处和风险对于大面积缺血的老年患者至关重要，由于高龄和广泛脑梗死的结合可能会对临床结局产生负面影响。方法本研究回顾性分析了老年脑卒中患者的临床结局（年龄≥ 70岁）伴大缺血核心（阿尔伯塔卒中项目早期CT评分[ASPECTS] < 6或缺血核心≥ 70 ml）使用我们的前瞻性数据库中2018年6月至2022年1月的数据。研究了EVT在这些患者中的有效性和风险，主要结局为一般结局（改良兰金量表，mRS ≤ 3分）。结果182例老年大缺血核心体积患者中，（EVT组120例，非EVT组62例），20.9%（38/182，EVT组22.5% vs.非EVT组17.7%）获得了一般结局。同时，49.5%（90/182，EVT组45.8% vs非EVT组56.5%）的患者在3个月时死亡。对于年龄≤ ~ 85岁或不匹配体积≥ ~ 50 ml的患者，EVT的获益在数值上超过非EVT治疗。然而，调整后，EVT与症状性颅内出血的风险增加（aOR 4.24，95%CI 1.262-14.247）。结论这项研究强调了老年大梗死患者面临的临床挑战，导致3个月的不良结局。EVT在这一人群中仍可能提供一些益处，但它也增加了颅内出血的风险。
BackgroundUnderstanding the benefits and risks of endovascular therapy (EVT) is crucial for elderly patients with large ischemic cores, as the combination of advanced age and extensive brain infarction may negatively impact clinical outcomes.MethodsThe study retrospectively analyzed clinical outcomes for elderly stroke patients (age ≥ 70) with large ischemic cores (Alberta Stroke Program Early CT Score [ASPECTS] < 6 or ischemic cores ≥ 70 ml) in the anterior circulation using data from our prospective database between June 2018 and January 2022. The effectiveness and risks of EVT in those patients were investigated, with the primary outcome being fair outcome (modified Rankin Scale, mRS ≤ 3).ResultsAmong 182 elderly patients with large ischemic core volume (120 in the EVT group and 62 in the non-EVT group), 20.9% (38/182, 22.5% in the EVT group vs. 17.7% in the non-EVT group) achieved a fair outcome. Meanwhile, 49.5% (90/182, 45.8% in the EVT group vs. 56.5% in the non-EVT group) of them died at 3 months. The benefits of EVT numerically exceeded non-EVT treatment for those aged ≤ ~ 85 years or with a mismatch volume ≥ ~ 50 ml. However, after adjustment, EVT was associated with an increased risk of symptomatic intracranial hemorrhage (aOR 4.24, 95%CI 1.262–14.247).ConclusionsThis study highlights the clinical challenges faced by elderly patients with large infarctions, resulting in poor outcomes at 3 months. EVT may still provide some benefits in this population, but it also carries an increased risk of intracranial hemorrhage.