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 t...
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 ${\geq}80$ 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 (${\geq}80$ 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.
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 ${\geq}80$ 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 (${\geq}80$ 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.
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제안 방법
In this study, several infarction risk factors and occlusion vascular sites were identified, using intravenous tPA, time from symptom onset to ER visit, and procedure time. These results showed a few relevant factors, including male sex and tPA, that differed according to the age-related group.
Patient data were collected including demographic data (sex and age), infarction risk factors, vascular occlusion sites, the use of intravenous tPA, time from symptom onset to ER visit, procedure time, complications (hemorrhage, progression, brain edema, and mortality) and need for secondary operation. Initial severity was assessed by the National Institutes of Health Stroke Scale (NIHSS).
대상 데이터
A total of 171 patients were treated with endovascular thrombectomy for acute ischemic stroke in our institution between January 1, 2010 and June 30, 2015. Among these patients, 113 were senior patients, over 60 years of age, who underwent mechanical thrombectomy. Within this group of patients, 20 (17.
This study was approved by the Institutional Review Board and we retrospectively reviewed 113 senior patients (over 60 years old) who were treated for acute ischemic stroke with mechanical thrombectomy at our institution between January 2010 and June 2015. The patients were divided into two subgroups : those between 60 and 79 years old and those 80 years of age or over.
데이터처리
Statistical analysis was performed using SPSS version 18.0 (IBM Corp., Armonk, NY, USA), continuous variables are presented as means plus or minus standard deviations, and variables were compared between the two subgroups using the Wilcoxon rank sum test for continuous variables and the chisquare or Fisher exact test for categorical variables. Univariate logistic regression models were used for the calculation of the odds ratio and their 95% confidence intervals.
이론/모형
Reperfusion was classified using the modified thrombolysis in cerebral infarction (TICI) scale. Functional outcomes at discharge were measured according to the modified Rankin Scale (mRS). Mechanical thrombectomy was defined as the intra-arterial procedure including stent-retriever systems, the Penumbra system (Penumbra Inc.
Patient data were collected including demographic data (sex and age), infarction risk factors, vascular occlusion sites, the use of intravenous tPA, time from symptom onset to ER visit, procedure time, complications (hemorrhage, progression, brain edema, and mortality) and need for secondary operation. Initial severity was assessed by the National Institutes of Health Stroke Scale (NIHSS). Reperfusion was classified using the modified thrombolysis in cerebral infarction (TICI) scale.
Initial severity was assessed by the National Institutes of Health Stroke Scale (NIHSS). Reperfusion was classified using the modified thrombolysis in cerebral infarction (TICI) scale. Functional outcomes at discharge were measured according to the modified Rankin Scale (mRS).
성능/효과
However in the latter part of the study, the use of stent retrievers and balloon guiding catheters due to development of the devices appeared to improve the results of treatment. Finally, the evaluated outcome was discharge mRS, the follow-up period was variable, ranging from two days to several weeks, which could be too short to accurately assess the results.
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