J Clin Neurol.  2017 Apr;13(2):162-169. 10.3988/jcn.2017.13.2.162.

Impact of Baseline Ischemia on Outcome in Older Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

• Hwang YH
• Kim YW
• Kang DH
• Kim YS
• Liebeskind DS

• KMID: 2376017
• DOI: http://doi.org/10.3988/jcn.2017.13.2.162

Abstract

BACKGROUND AND PURPOSE
The outcome for older stroke patients who undergo endovascular revascularization remains unsatisfactory. We aimed to determine the effect of the extent of baseline ischemia on outcome according to age, testing the hypothesis that the restorative capacity for recovery is only marginal in older patients.
METHODS
Two hundred and thirteen patients who underwent endovascular revascularization due to occlusion in the M1 segment of the middle cerebral artery (with or without internal carotid artery occlusions) were selected for analysis. Patients were categorized into three age groups: group A (<66 years), group B (66-75 years), and group C (>75 years). Using pretreatment diffusion-weighted imaging (DWI), the Alberta Stroke Program Early CT Score (ASPECTS) and lesion volume were independently measured and analyzed in relation to a favorable outcome.
RESULTS
A favorable outcome was achieved in 111 of 213 patients overall: in 60 of the 94 (63.8%) patients in group A, in 36 of the 70 (51.4%) patients in group B, and in 15 of the 49 (30.6%) patients in group C (p=0.001). In older stroke patients (group C), a DWI ASPECTS ≥9 and lesion volume ≤5 mL were found to predict a favorable outcome, which was more restrictive than the cutoffs for their younger counterparts (groups A and B; DWI ASPECTS ≥8 and lesion volume ≤20 mL).
CONCLUSIONS
The age-adjusted pretreatment DWI lesion volume and ASPECTS may represent useful surrogate markers for functional outcome according to age. The use of more-restrictive inclusion criteria for older stroke patients could be warranted, although larger studies are necessary to confirm these findings.

Keyword

stroke; reperfusion; diffusion; aging

MeSH Terms

Aging
Alberta
Biomarkers
Carotid Artery, Internal
Diffusion
Humans
Ischemia*
Middle Cerebral Artery
Reperfusion
Stroke*
Biomarkers

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curves for favorable outcome and the baseline diffusion-weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) and lesion volume according to the age groups. The tables display the test characteristics for the prespecified ASPECTS and lesion volume, including optimal values (*). AUC: area under the ROC curve, CI: confidence interval, mRS: modified Rankin scale.

• 

  Fig. 2 Schematic of the hypothetical inverse sinusoidal relationships between advancing age and restorative brain capacity. Between points A and B, the restorative capacity decreases steeply for small age increase. ASPECTS: Alberta Stroke Program Early CT Score, DWI: diffusion-weighted imaging.

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