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

Fabrizio Sallustio, MD; Giacomo Koch, PhD; Caterina Motta, MD; Marina Diomedi, MD; Fana Alemseged, MD; Vittoria C. D'Agostino, MD; Simone Napolitano, MD; Domenico Samà, MD; Alessandro Davoli, MD; Daniel Konda, MD; Daniele Morosetti, MD; Enrico Pampana, MD; Roberto Floris, MD; Roberto Gandini, MD

Disclosures

J Am Geriatr Soc. 2017;65(8):1816-1820. 

In This Article

Results

Of 254 individuals treated with thrombectomy between August 2009 and June 2016, 219 fulfilled selection criteria and were included in the analysis. Of 35 individuals excluded, two were lost to follow-up and 33 had an onset to groin puncture time of more than 5 hours (mean 351 minutes (range 305–605 minutes). Of the 219 selected individuals, 157 were younger than 80, and 62 were aged 80 and older. Table 1 shows the clinical and radiological baseline and demographic characteristics of the two groups. Older participants were more likely to have atrial fibrillation and hypertension and were more often female. As shown in Table 2, they were more frequently treated with IVT, intravenous heparin, and conscious sedation during the procedure and were more quickly reperfused than the younger group.

When evaluating safety and efficacy endpoints in the univariate analysis (Table 3), higher 24-hour ASPECTS were found in the older group, indicating smaller infarct size, whereas no differences were found in the rate of hemorrhagic complications, in 3-month clinical outcomes, or in global mortality and mortality secondary to neurological deterioration. All factors that might be associated with 3-month functional clinical outcomes in the elderly and younger groups were analyzed. In both groups, lower onset NIHSS score, higher baseline and 24-hour ASPECTS, good collateral flow, and 24-hour clinical improvement were associated with functional independence at 3-month follow-up. Functional outcome was associated with baseline glycemia and sICH rate only in the younger group and with a shorter groin-to-reperfusion time only in the older group (Table S1).

In the multivariate analysis, factors associated with 3-month functional independence were 24-hour clinical improvement (odds ratio (OR) = 7.59, 95% confidence interval (CI) = 1.9–28.8, P = .003) and number of device passages (OR = 0.48, 95% CI = 0.29–0.78; P = .004) in the younger group (Table S2), onset NIHSS score (OR = 0.65, 95% CI = 0.44–0.96, P = .03) and 24-hour clinical improvement (OR = 141.13, 95% CI = 2.96–6,720.7, P = .01) in the older group (Table 4).

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