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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Nogueira RG, "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct" 378 : 11-21, 2018

2 Cohen JE, "Stent retriever-based thrombectomy in octogenarians" 5 : 111-117, 2016

3 Larrue V, "Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator : a secondary analysis of the European-Australasian Acute Stroke Study(ECASS II)" 32 : 438-441, 2001

4 Zaidat OO, "Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement" 44 : 2650-2663, 2013

5 Kurre W, "Predictors of outcome after mechanical thrombectomy for anterior circulation large vessel occlusion in patients aged ≥80 years" 36 : 430-436, 2013

6 Barral M, "Predictors of favorable outcome after mechanical thrombectomy for anterior circulation acute ischemic stroke in octogenarians" 45 : 211-216, 2018

7 윤웅, "Predictive Factors for Good Outcome and Mortality After Stent-Retriever Thrombectomy in Patients With Acute Anterior Circulation Stroke" 대한뇌졸중학회 19 (19): 97-103, 2017

8 Danière F, "Patient selection for stroke endovascular therapy--DWIASPECTS thresholds should vary among age groups : insights from the RECOST study" 36 : 32-39, 2015

9 Alawieh A, "Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study" 11 : 545-553, 2019

10 Koizumi S, "Onset to reperfusion time was not important in mechanical thrombectomy for elderly patients : a retrospective multicenter study in Tama area, Tokyo" 46 : 89-96, 2018

11 Slawski DE, "Mechanical thrombectomy in elderly stroke patients with mild-to-moderate baseline disability" 7 : 246-255, 2018

12 Imahori T, "Mechanical thrombectomy for acute ischemic stroke patients aged 80 years or older" 26 : 2793-2799, 2017

13 Mokin M, "Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS standards and guidelines committee" 11 : 215-220, 2019

14 Jayaraman MV, "Endovascular treatment of anterior circulation large vessel occlusion in the elderly" 8 : 713-, 2018

15 Yoon W, "Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke" 76 : 680-686, 2015

16 Goyal M, "Endovascular thrombectomy after large-vessel ischaemic stroke: a metaanalysis of individual patient data from five randomised trials" 387 : 1723-1731, 2016

17 Lima A, "Endovascular therapy for large vessel stroke in the elderly : hope in the new stroke era" 42 : 421-427, 2016

18 Hilditch CA, "Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis" 39 : 887-891, 2018

19 Neugebauer H, "DESTINY-S : attitudes of physicians toward disability and treatment in malignant MCA infarction" 21 : 27-34, 2014

20 Chandra RV, "Clinical outcome after intra-arterial stroke therapy in the very elderly: why is it so heterogeneous?" 5 : 60-, 2014

21 Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment" 24 : 35-41, 1993

22 Ribo M, "Age-adjusted infarct volume threshold for good outcome after endovascular treatment" 6 : 418-422, 2014