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Efficacy and Safety of Mechanical Thrombectomy in Older Adults with Acute Ischemic Stoke.

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Title: Efficacy and Safety of Mechanical Thrombectomy in Older Adults with Acute Ischemic Stoke.
Authors: Sallustio, Fabrizio, Koch, Giacomo, Motta, Caterina, Diomedi, Marina, Alemseged, Fana, D'Agostino, Vittoria C., Napolitano, Simone, Samà, Domenico, Davoli, Alessandro, Konda, Daniel, Morosetti, Daniele, Pampana, Enrico, Floris, Roberto, Gandini, Roberto
Source: Journal of the American Geriatrics Society. Aug2017, Vol. 65 Issue 8, p1816-1820. 5p. 4 Charts.
Subjects: Stroke treatment, Thrombolytic therapy, Academic medical centers, Patient safety
Geographic Terms: Italy
Abstract: Objectives To evaluate the safety and efficacy of endovascular therapy in elderly adults treated for acute ischemic stroke. Design Retrospective cohort study. Setting Comprehensive Stroke Center, University of Tor Vergata, Rome, Italy. Participants Elderly adults treated for acute ischemic stroke (N = 219). Measurements Participants were divided into two groups based on their age (n = 62, ≥80; n = 157, <80). Baseline and procedural characteristics, safety outcomes such as intracranial hemorrhage ( ICH) and mortality and efficacy outcomes such as successful reperfusion and 3-month good clinical outcome of the two groups were compared. Mutivariable analysis was performed to identify predictors of clinical outcome. Results Intravenous thrombolysis was more frequent (67.7% vs 52.8%, P = .04), and onset to reperfusion time was shorter (318.7 ± 128.7 vs 282 ± 53.5, P = .02) in participants aged 80 and older, but no between-group differences were found in terms of successful reperfusion (69% vs 63%, P = .4), good clinical outcome (30.6% vs 34.3%, P = .6), any (37% vs 37.5%, P > .99) or symptomatic (11% vs 14%, P = .6) ICH, or mortality (40.3% vs 29.2%, P = .14). Multivariable analysis revealed that, in the older group, onset National Institute of Health Stroke Scale ( NIHSS) score (odds ratio ( OR) = 0.65, 95% confidence interval ( CI) = 0.44-0.96, P = .03) and 24-hour clinical improvement ( OR = 141.13, 95% CI = 2.96-6,720.7, P = .01) were independent predictors of 3-month functional independence. Conclusion These findings suggest that endovascular treatment for stroke in selected elderly adults could be safe and effective. Major determinants of outcome in this subgroup of elderly patients are presentation NIHSS score and 24-hour clinical improvement. [ABSTRACT FROM AUTHOR]
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Database: Psychology and Behavioral Sciences Collection
Description
Abstract:Objectives To evaluate the safety and efficacy of endovascular therapy in elderly adults treated for acute ischemic stroke. Design Retrospective cohort study. Setting Comprehensive Stroke Center, University of Tor Vergata, Rome, Italy. Participants Elderly adults treated for acute ischemic stroke (N = 219). Measurements Participants were divided into two groups based on their age (n = 62, ≥80; n = 157, <80). Baseline and procedural characteristics, safety outcomes such as intracranial hemorrhage ( ICH) and mortality and efficacy outcomes such as successful reperfusion and 3-month good clinical outcome of the two groups were compared. Mutivariable analysis was performed to identify predictors of clinical outcome. Results Intravenous thrombolysis was more frequent (67.7% vs 52.8%, P = .04), and onset to reperfusion time was shorter (318.7 ± 128.7 vs 282 ± 53.5, P = .02) in participants aged 80 and older, but no between-group differences were found in terms of successful reperfusion (69% vs 63%, P = .4), good clinical outcome (30.6% vs 34.3%, P = .6), any (37% vs 37.5%, P > .99) or symptomatic (11% vs 14%, P = .6) ICH, or mortality (40.3% vs 29.2%, P = .14). Multivariable analysis revealed that, in the older group, onset National Institute of Health Stroke Scale ( NIHSS) score (odds ratio ( OR) = 0.65, 95% confidence interval ( CI) = 0.44-0.96, P = .03) and 24-hour clinical improvement ( OR = 141.13, 95% CI = 2.96-6,720.7, P = .01) were independent predictors of 3-month functional independence. Conclusion These findings suggest that endovascular treatment for stroke in selected elderly adults could be safe and effective. Major determinants of outcome in this subgroup of elderly patients are presentation NIHSS score and 24-hour clinical improvement. [ABSTRACT FROM AUTHOR]
ISSN:00028614
DOI:10.1111/jgs.14909