Top

Neurological Sciences

Published in:

12-09-2023 | Stroke | Original Article

Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores

Authors: Qian Liu, Jinghuan Fang, Xin Jiang, Ting Duan, Yaxi Luo, Lijie Gao, Shuju Dong, Mengmeng Ma, Muke Zhou, Li He

Published in: Neurological Sciences | Issue 2/2024

Abstract

Background

Understanding the benefits and risks of endovascular therapy (EVT) is crucial for elderly patients with large ischemic cores, as the combination of advanced age and extensive brain infarction may negatively impact clinical outcomes.

Methods

The study retrospectively analyzed clinical outcomes for elderly stroke patients (age ≥ 70) with large ischemic cores (Alberta Stroke Program Early CT Score [ASPECTS] < 6 or ischemic cores ≥ 70 ml) in the anterior circulation using data from our prospective database between June 2018 and January 2022. The effectiveness and risks of EVT in those patients were investigated, with the primary outcome being fair outcome (modified Rankin Scale, mRS ≤ 3).

Results

Among 182 elderly patients with large ischemic core volume (120 in the EVT group and 62 in the non-EVT group), 20.9% (38/182, 22.5% in the EVT group vs. 17.7% in the non-EVT group) achieved a fair outcome. Meanwhile, 49.5% (90/182, 45.8% in the EVT group vs. 56.5% in the non-EVT group) of them died at 3 months. The benefits of EVT numerically exceeded non-EVT treatment for those aged ≤ ~ 85 years or with a mismatch volume ≥ ~ 50 ml. However, after adjustment, EVT was associated with an increased risk of symptomatic intracranial hemorrhage (aOR 4.24, 95%CI 1.262–14.247).

Conclusions

This study highlights the clinical challenges faced by elderly patients with large infarctions, resulting in poor outcomes at 3 months. EVT may still provide some benefits in this population, but it also carries an increased risk of intracranial hemorrhage.

Available only for authorised users

Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387:1723–1731. https://doi.org/10.1016/S0140-6736(16)00163-X. 2016/02/24CrossRefPubMed

Powers WJ, Rabinstein AA, Ackerson T et al (2019) Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 50:e344–e418. https://doi.org/10.1161/STR.0000000000000211CrossRefPubMed

Nogueira RG, Haussen DC, Liebeskind D et al (2021) Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows. Stroke 52:491–497. https://doi.org/10.1161/STROKEAHA.120.031685CrossRefPubMed

Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 378:11–21. https://doi.org/10.1056/NEJMoa1706442. 2017/11/14CrossRefPubMed

Finitsis S, Epstein J, Richard S et al (2021) Age and Outcome after Endovascular Treatment in Anterior Circulation Large-Vessel Occlusion Stroke: ETIS Registry Results. Cerebrovasc Dis 50:68–77. https://doi.org/10.1159/000512203. 2020/12/16CrossRefPubMed

Yoshimura S, Sakai N, Yamagami H et al (2022) Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med 386:1303–1313. https://doi.org/10.1056/NEJMoa2118191CrossRefPubMed

Sarraj A, Grotta JC, Pujara DK et al (2020) Triage imaging and outcome measures for large core stroke thrombectomy - a systematic review and meta-analysis. J Neurointerv Surg 12:1172–1179. https://doi.org/10.1136/neurintsurg-2019-015509CrossRefPubMed

Campbell BCV, Majoie C, Albers GW et al (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 18:46–55. https://doi.org/10.1016/S1474-4422(18)30314-4. 2018/11/11CrossRefPubMed

Lehrieder D, Layer K, Muller HP et al (2021) Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction. Neurology 96:e2704–e2713. https://doi.org/10.1212/WNL.0000000000011987CrossRefPubMed

10.

Luo Y, Chen M, Fang J, et al. (2022) Relationship Between Body Temperature and Early Neurological Deterioration after Endovascular Thrombectomy for Acute Ischemic Stroke with Large Vessel Occlusion. Neurocrit Care https://doi.org/10.1007/s12028-021-01416-9

11.

Hacke W, Kaste M, Fieschi C et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352:1245–1251. https://doi.org/10.1016/s0140-6736(98)08020-9CrossRefPubMed

12.

Alawieh A, Starke RM, Chatterjee AR et al (2019) Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study. J Neurointerv Surg 11:545–553. https://doi.org/10.1136/neurintsurg-2018-014289. 2018/11/06CrossRefPubMed

13.

Ospel J, Kappelhof M, Groot AE et al (2020) Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry. Stroke 51:3742–3745. https://doi.org/10.1161/STROKEAHA.120.031773CrossRefPubMed

14.

Ospel JM, Kappelhof M, Kashani N et al (2021) Effect of age and baseline ASPECTS on outcomes in large-vessel occlusion stroke: results from the HERMES collaboration. J Neurointerv Surg 13:790–793. https://doi.org/10.1136/neurintsurg-2020-016621. 2020/09/16CrossRefPubMed

15.

Yang W, Zhang L, Yao Q et al (2020) Endovascular treatment or general treatment: how should acute ischemic stroke patients choose to benefit from them the most?: A systematic review and meta-analysis. Medicine (Baltimore) 99:e20187. https://doi.org/10.1097/MD.0000000000020187CrossRefPubMed

16.

Pohjasvaara T, Erkinjuntti T, Vataja R et al (1997) Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years. Stroke 28:729–735. https://doi.org/10.1161/01.str.28.4.729CrossRefPubMed

17.

Meyer L, Alexandrou M, Flottmann F et al (2020) Endovascular Treatment of Very Elderly Patients Aged >/=90 With Acute Ischemic Stroke. J Am Heart Assoc 9:e014447. https://doi.org/10.1161/JAHA.119.014447CrossRefPubMedPubMedCentral

18.

Garcia-Esperon C, Bivard A, Johns H, et al. (2022) Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core. Neurology https://doi.org/10.1212/WNL.0000000000200908

19.

Sarraj A, Hassan AE, Savitz S et al (2019) Outcomes of Endovascular Thrombectomy vs Medical Management Alone in Patients With Large Ischemic Cores: A Secondary Analysis of the Optimizing Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) Study. JAMA Neurol 76:1147–1156. https://doi.org/10.1001/jamaneurol.2019.2109CrossRefPubMedPubMedCentral

20.

Yoshimoto T, Inoue M, Tanaka K et al (2021) Identifying large ischemic core volume ranges in acute stroke that can benefit from mechanical thrombectomy. J Neurointerv Surg 13:1081–1087. https://doi.org/10.1136/neurintsurg-2020-016934. 2020/12/17CrossRefPubMed

21.

Zaidat OO, Liebeskind DS, Jadhav AP et al (2021) Impact of Age and Alberta Stroke Program Early Computed Tomography Score 0 to 5 on Mechanical Thrombectomy Outcomes: Analysis From the STRATIS Registry. Stroke 52:2220–2228. https://doi.org/10.1161/STROKEAHA.120.032430CrossRefPubMedPubMedCentral

22.

Seners P, Oppenheim C, Turc G et al (2021) Perfusion Imaging and Clinical Outcome in Acute Ischemic Stroke with Large Core. Ann Neurol 90:417–427. https://doi.org/10.1002/ana.26152CrossRefPubMed

23.

Alexandre AM, Pedicelli A, Valente I et al (2020) endovascular thrombectomy without CT perfusion improve clinical outcome? Clin Neurol Neurosurg 198:106207. https://doi.org/10.1016/j.clineuro.2020.106207CrossRefPubMed

Title: Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores
Authors: Qian Liu
Jinghuan Fang
Xin Jiang
Ting Duan
Yaxi Luo
Lijie Gao
Shuju Dong
Mengmeng Ma
Muke Zhou
Li He
Publication date: 12-09-2023
Publisher: Springer International Publishing
Keywords: Stroke
Thrombectomy
Published in: Neurological Sciences / Issue 2/2024
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-023-06995-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endovascular thrombectomy for acute ischemic stroke in elderly patients with large ischemic cores

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2024

Olfactory status in neurodegeneration with brain iron accumulation disorders

Accurately predicting the risk of unfavorable outcomes after endovascular coil therapy in patients with aneurysmal subarachnoid hemorrhage: an interpretable machine learning model

Differentiating progressive supranuclear palsy from other movement disorders using transcranial sonography: a systematic review and meta-analysis

The effects of different acetylcholinesterase inhibitors on EEG patterns in patients with Alzheimer’s disease: A systematic review

How can sleep disorders affect our reaction towards external stressors: a lesson from the COVID-19 outbreak

Neurological and neuromuscular manifestations in patients with West Nile neuroinvasive disease, Belgrade area, Serbia, season 2022