J Korean Neurosurg Soc.  2017 Nov;60(6):654-660. 10.3340/jkns.2016.1212.004.

Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients: A Single Center Experience

• Kim DH
• Kim SU
• Sung JH
• Lee DH
• Yi HJ
• Lee SW

• KMID: 2395784
• DOI: http://doi.org/10.3340/jkns.2016.1212.004

Abstract

OBJECTIVE
Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ≥80 years) and aged patients (60-79 years) treated with mechanical thrombectomy.
METHODS
Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (≥80 years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported.
RESULTS
The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed.
CONCLUSION
Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

Keyword

Infarction; Aged; Thrombectomy; Aged; 80 and over

MeSH Terms

Aged*
Brain Ischemia
Humans
Infarction*
Mortality
Odds Ratio
Retrospective Studies
Stroke
Thrombectomy*

Figure

• 

  Fig. 1 Discharge modified Rankin Scale (mRS) score in very elderly patients (age ≥80 years) and aged patient (60–79 years).

Reference

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