Outcomes of endovascular thrombectomy in the elderly: a 'real-world' multicenter study
Outcomes of endovascular thrombectomy in the elderly: a 'real-world' multicenter study
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DOI：
10.1136/neurintsurg-2018-014289
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发表时间：
2019-06-01
影响因子：
4.8
通讯作者：
Spiotta, Alejandro M.
中科院分区：
文献类型：
--
作者：
Alawieh, Ali;Starke, Robert M.;Spiotta, Alejandro M.
背景血管内血栓切除术（ET）治疗八十多岁急性缺血性中风（AIS）的有效性仍然存在争议。目的通过一个大型多中心队列研究，评价高龄患者与年轻患者行ET后的结局。方法回顾了2013年1月至2018年1月期间在美国7家综合性卒中中心接受ET治疗AIS患者的前瞻性维护数据库的数据。收集人口统计学、手术和结局变量。结局包括90天改良兰金量表（mRS）评分、术后国立卫生研究院卒中量表评分、术后出血和死亡率。进行单变量和多变量分析，以评估年龄≥ 80岁对结局指标的独立影响。还根据卒中位置、再通成功率或所用ET技术进行了亚组分析。结果老年患者ET后的功能独立率（mRS评分0-2分）明显低于年轻患者。年龄≥ 80岁与死亡率增加和预后不良独立相关。年龄≥ 80岁对结局显示出独立的负面预后影响，即使根据血栓切除术技术、卒中位置或再通成功率对患者进行分组。年龄≥ 80岁独立预测术后出血率较高，但不能预测再通成功率。基线缺陷和再灌注尝试次数，但脑梗死溶栓评分与较低的良好结局几率无关。结论：当使用与年轻人群相似的选择标准时，ET对AIS结局的大效应量在老年人群中显著减少。这引起了人们对在优化患者选择之前在老年人中进行该手术的风险效益比和成本效益的担忧。
Background The efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial. Objective To evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared with younger patients. Methods Data from prospectively maintained databases of patients undergoing ET for AIS at seven US-based comprehensive stroke centers between January 2013 and January 2018 were reviewed. Demographic, procedural, and outcome variables were collected. Outcomes included 90-day modified Rankin Scale (mRS) score, postprocedural National Institutes of Health Stroke Scale score, postprocedural hemorrhage, and mortality. Univariate and multivariate analyses were performed to assess the independent effect of age= 80 on outcome measures. Subgroup analyses were also performed based on location of stroke, success of recanalization, or ET technique used. Results R ates of functional independence (mRS score 0-2) after ET in elderly patients were significantly lower than for younger counterparts. Age= 80 was independently associated with increased mortality and poor outcome. Age= 80 showed an independent negative prognostic effect on outcome even when patients were divided according to thrombectomy technique, location of stroke, or success of recanalization. Age= 80 independently predicted higher rate of postprocedural hemorrhage, but not success of recanalization. Baseline deficit and number of reperfusion attempts, but not Thrombolysis in Cerebral Infarction score were associated with lower odds of good outcome. Conclusion The large effect size of ET on AIS outcomes is significantly diminished in the elderly population when using comparable selection criteria to those used in younger counterparts. This raises concerns about the risk-benefit ratio and the cost-effectiveness of performing this procedure in the elderly before optimizing patient selection.