Efficacy analysis of endovascular therapy in elderly patients with acute ischemic stroke_West China Medical Journal

Authors：

XIONG Yao , ZHANG Haitao , XU Guanghui , MAO Rui , PU Ju , LI Deng , HU Rong , MA Hao ,  LIU Hua

Department of Neurology, the Third People’s Hospital of Chengdu & the Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Hua, Email: hxliumedidoctor@163.com

Keywords：

Ischemic stroke; elderly; endovascular therapy

DOI：

10.7507/1002-0179.202304025

Video：

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Objective To explore the efficacy of endovascular therapy in elderly patients with acute ischemic stroke. Methods The acute ischemic stroke patients who received endovascular therapy between January 2020 and January 2023 were retrospectively enrolled. According to age, patients were divided into the elderly group (≥ 80 years old) and other age groups (<80 years old). The baseline data, green channel data, nerve function deficit, recanalization and complication information were collected, and the patients were followed up. Modified Rankin Scale (mRS) was used to evaluate patients prognosis at 3 months after onset. Score less than or equal to 2 points was defined as good prognosis and over 2 points was defined as poor prognosis. Results A total of 138 patients were included, and 7 patients were lost to follow-up. Finally, 131 patients were included. Among them, there were 50 cases in the elderly group and 81 cases in the other age group. There were statistically significant differences in age, hypertension, atrial fibrillation, and vascular recanalization between the elderly group and the other age group (P<0.05). There was no statistically significant difference in the other baseline data, complications, 3-month prognosis, or mortality between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that the National Institute of Health Stroke Scale score at admission [odds ratio (OR)=1.150, 95% confidence interval (CI) (1.033, 1.281), P=0.011], pulmonary infection [OR=2.933, 95%CI (1.109, 7.758), P=0.030], and hypoproteinemia [OR=3.716, 95%CI (1.226, 11.264), P=0.020] affected the mRS score at 3 months after onset. Conclusions Among the patients with acute ischemic stroke undergoing endovascular therapy, there is no difference in the occurrence of complications or short-term prognosis between elderly patients and other age patients. However, the attention should still be paid to reducing the occurrence of complications in patients, strengthening their nutritional support, and thereby improving their prognosis.

Citation： XIONG Yao, ZHANG Haitao, XU Guanghui, MAO Rui, PU Ju, LI Deng, HU Rong, MA Hao, LIU Hua. Efficacy analysis of endovascular therapy in elderly patients with acute ischemic stroke. West China Medical Journal, 2023, 38(8): 1154-1159. doi: 10.7507/1002-0179.202304025 Copy

1.	Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2.	Tsai CF, Thomas B, Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology, 2013, 81(3): 264-272.
3.	Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 Study. Neuroepidemiology, 2015, 45(3): 161-176.
4.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
5.	Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol, 2016, 15: 1138-1147.
6.	Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med, 2018, 378(1): 11-21.
7.	Rezai MK, Advani R, Dalen I, et al. Endovascular thrombectomy in the elderly: do radiological and clinical outcomes differ from those in younger patients? A prospective single-center experience. Cerebrovasc Dis, 2019, 47(1/2): 65-71.
8.	Hilditch CA, Nicholson P, Murad MH, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(5): 887-891.
9.	Neves G, Warman P, Bueso T, et al. Identification of successful cerebral reperfusions (mTICI ≥2b) using an artificial intelligence strategy. Neuroradiology, 2022, 64(5): 991-997.
10.	Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med, 1982, 306(17): 1018-1022.
11.	Pillai P, Bush SJ, Kusuma Y, et al. Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusio. J Neurointerv Sur, 2023: jnis-2023-020512.
12.	Brinjikji W, Nogueira RG, Kvamme P, et al. Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the stroke thromboembolism registry of imaging and pathology. J Neurointerv Surg, 2021, 13(7): 594-598.
13.	杜娟, 林甜, 孔祥锴, 等. 高龄急性大血管闭塞性卒中患者取栓治疗的特点及疗效研究. 中国脑血管病杂志, 2022, 19(2): 101-108.
14.	胡玉奇, 贾琦, 代林志, 等. 高龄急性前循环脑梗死患者支架取栓术预后分析. 中国实用神经疾病杂志, 2022, 25(6): 699-704.
15.	徐祥辉, 刘春林, 郭志勇, 等. 应用颅内取栓支架治疗高龄急性缺血性脑卒中患者的临床观察. 心脑血管病防治, 2021, 21(6): 595-597.
16.	Azkune Calle I, Bocos Portillo J, Anton-Ladislao A, et al. Clinical outcome of mechanical thrombectomy for stroke in the elderly. J Stroke Cerebrovasc Dis, 2017, 26(3): 582-588.
17.	Hwang K, Hwang G, Kwon OK, et al. Endovascular treatment for acute ischemic stroke patients over 80 years of age. J Cerebrovasc Endovasc Neurosurg, 2015, 17(3): 173-179.
18.	Adcock AK, Schwamm LH, Smith EE, et al. Trends in use, outcomes, and disparities in endovascular thrombectomy in us patients with stroke aged 80 years and older compared with younger patients. JAMA Netw Open, 2022, 5(6): e2215869.
19.	Alawieh A, Starke RM, Chatterjee AR, et al. Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study. J Neurointerv Surg, 2019, 11(6): 545-553.
20.	Inoue M, Ota T, Hara T, et al. An initial high national institutes of health stroke scale score and any intracranial hemorrhage are independent factors for a poor outcome in nonagenarians treated with thrombectomy for acute large vessel occlusion: the Tokyo/Tama-registry of acute endovascular thrombectomy (TREAT) study. World Neurosurg, 2022, 165: e325-e330.
21.	Hong KS, Kang DW, Koo JS, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol, 2008, 15(12): 1324-1331.
22.	Junttola U, Lahtinen S, Liisanantti J, et al. Medical complications and outcome after endovascular therapy for acute ischemic stroke. Acta Neurol Scand, 2021, 144(6): 623-631.
23.	Shaikh F, Shaikh FH, Chandio SA. Frequency of hypoalbuminemia and in-hospital mortality in acute ischemic stroke patients presenting at a tertiary care hospital, hyderabad. Cureus, 2021, 13(4): e14256.

1. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
2. Tsai CF, Thomas B, Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology, 2013, 81(3): 264-272.
3. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 Study. Neuroepidemiology, 2015, 45(3): 161-176.
4. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南 2018. 中华神经科杂志, 2018, 51(9): 666-682.
5. Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol, 2016, 15: 1138-1147.
6. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med, 2018, 378(1): 11-21.
7. Rezai MK, Advani R, Dalen I, et al. Endovascular thrombectomy in the elderly: do radiological and clinical outcomes differ from those in younger patients? A prospective single-center experience. Cerebrovasc Dis, 2019, 47(1/2): 65-71.
8. Hilditch CA, Nicholson P, Murad MH, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(5): 887-891.
9. Neves G, Warman P, Bueso T, et al. Identification of successful cerebral reperfusions (mTICI ≥2b) using an artificial intelligence strategy. Neuroradiology, 2022, 64(5): 991-997.
10. Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med, 1982, 306(17): 1018-1022.
11. Pillai P, Bush SJ, Kusuma Y, et al. Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusio. J Neurointerv Sur, 2023: jnis-2023-020512.
12. Brinjikji W, Nogueira RG, Kvamme P, et al. Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the stroke thromboembolism registry of imaging and pathology. J Neurointerv Surg, 2021, 13(7): 594-598.
13. 杜娟, 林甜, 孔祥锴, 等. 高龄急性大血管闭塞性卒中患者取栓治疗的特点及疗效研究. 中国脑血管病杂志, 2022, 19(2): 101-108.
14. 胡玉奇, 贾琦, 代林志, 等. 高龄急性前循环脑梗死患者支架取栓术预后分析. 中国实用神经疾病杂志, 2022, 25(6): 699-704.
15. 徐祥辉, 刘春林, 郭志勇, 等. 应用颅内取栓支架治疗高龄急性缺血性脑卒中患者的临床观察. 心脑血管病防治, 2021, 21(6): 595-597.
16. Azkune Calle I, Bocos Portillo J, Anton-Ladislao A, et al. Clinical outcome of mechanical thrombectomy for stroke in the elderly. J Stroke Cerebrovasc Dis, 2017, 26(3): 582-588.
17. Hwang K, Hwang G, Kwon OK, et al. Endovascular treatment for acute ischemic stroke patients over 80 years of age. J Cerebrovasc Endovasc Neurosurg, 2015, 17(3): 173-179.
18. Adcock AK, Schwamm LH, Smith EE, et al. Trends in use, outcomes, and disparities in endovascular thrombectomy in us patients with stroke aged 80 years and older compared with younger patients. JAMA Netw Open, 2022, 5(6): e2215869.
19. Alawieh A, Starke RM, Chatterjee AR, et al. Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study. J Neurointerv Surg, 2019, 11(6): 545-553.
20. Inoue M, Ota T, Hara T, et al. An initial high national institutes of health stroke scale score and any intracranial hemorrhage are independent factors for a poor outcome in nonagenarians treated with thrombectomy for acute large vessel occlusion: the Tokyo/Tama-registry of acute endovascular thrombectomy (TREAT) study. World Neurosurg, 2022, 165: e325-e330.
21. Hong KS, Kang DW, Koo JS, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol, 2008, 15(12): 1324-1331.
22. Junttola U, Lahtinen S, Liisanantti J, et al. Medical complications and outcome after endovascular therapy for acute ischemic stroke. Acta Neurol Scand, 2021, 144(6): 623-631.
23. Shaikh F, Shaikh FH, Chandio SA. Frequency of hypoalbuminemia and in-hospital mortality in acute ischemic stroke patients presenting at a tertiary care hospital, hyderabad. Cureus, 2021, 13(4): e14256.

West China Medical Journal

Efficacy analysis of endovascular therapy in elderly patients with acute ischemic stroke

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