Korean J Radiol.  2020 Jan;21(1):101-107. 10.3348/kjr.2019.0431.

Predictors of Catastrophic Outcome after Endovascular Thrombectomy in Elderly Patients with Acute Anterior Circulation Stroke

• Ahn Y
• Kim SK
• Baek BH
• Lee YY
• Lee HJ
• Yoon W

• KMID: 2467046
• DOI: http://doi.org/10.3348/kjr.2019.0431

Abstract

OBJECTIVE
Avoiding a catastrophic outcome may be a more realistic goal than achieving functional independence in the treatment of acute stroke in octogenarians. This study aimed to investigate predictors of catastrophic outcome in elderly patients after an endovascular thrombectomy with an acute anterior circulation large vessel occlusion (LVO).
MATERIALS AND METHODS
Data from 82 patients aged ≥ 80 years, who were treated with thrombectomy for acute anterior circulation LVO, were analyzed. The association between clinical/imaging variables and catastrophic outcomes was assessed. A catastrophic outcome was defined as a modified Rankin Scale score of 4-6 at 90 days.
RESULTS
Successful reperfusion was achieved in 61 patients (74.4%), while 47 patients (57.3%) had a catastrophic outcome. The 90-day mortality rate of the treated patients was 15.9% (13/82). The catastrophic outcome group had a significantly lower baseline diffusion-weighted imaging-Alberta stroke program early CT score (DWI-ASPECTS) (7 vs. 8, p = 0.014) and a longer procedure time (42 minutes vs. 29 minutes, p = 0.031) compared to the non-catastrophic outcome group. Successful reperfusion was significantly less frequent in the catastrophic outcome group (63.8% vs. 88.6%, p = 0.011) compared to the non-catastrophic outcome group. In a binary logistic regression analysis, DWI-ASPECTS (odds ratio [OR], 0.709; 95% confidence interval [CI], 0.524-0.960; p = 0.026) and successful reperfusion (OR, 0.242; 95% CI, 0.071-0.822; p = 0.023) were independent predictors of a catastrophic outcome.
CONCLUSION
Baseline infarct size and reperfusion status were independently associated with a catastrophic outcome after endovascular thrombectomy in elderly patients aged ≥ 80 years with acute anterior circulation LVO.

Keyword

Acute ischemic stroke; Mechanical thrombectomy; Acute large vessel occlusion; Octogenarian; Nonagenarian; Outcome predictor

MeSH Terms

Aged*
Aged, 80 and over
Humans
Logistic Models
Mortality
Reperfusion
Stroke*
Thrombectomy*

Figure

• 

  Fig. 1 Distribution of mRS scores at 90 days, according to DWI-ASPECTS, after thrombectomy in elderly patients with acute anterior circulation large vessel occlusion. DWI-ASPECTS = diffusion-weighted imaging Alberta stroke program early CT score, mRS = modified Rankin Scale

• 

  Fig. 2 Distribution of mRS scores at 90 days, according to reperfusion status, after thrombectomy in elderly patients with acute anterior circulation large vessel occlusion.

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