Does endovascular therapy change outcomes in nonagenarians with acute ischemic stroke?
Copyright © 2020 Elsevier Ltd. All rights reserved..
BACKGROUND: Ischemic strokes can be devastating for elderly patients, and randomized control trials of mechanical thrombectomy have shown encouraging results. We present the first analysis of clinical outcomes in nonagenarians with acute ischemic stroke treated with best medical therapy compared to endovascular revascularization therapy.
METHODS: A retrospective analysis was performed on 42 patients 90 years or older who were treated for acute ischemic stroke. Modified Rankin scores were calculated immediately post-injury, at discharge, and at 30 days and 90 days following discharge. Student's t-test and Wald tests were performed to evaluate whether endovascular treatment was associated with modified Rankin Score improvement at discharge, 30 days, or 90 days after discharge.
RESULTS: Follow-up data were available for 32/42 (76%) and 20/42 (48%) patients at 30 and 90 days after discharge, respectively. 8/9 (89%) patients who underwent endovascular treatment reached Thrombolysis in Cerebral Infarction scale 2b or better with no procedural complications. 12/42 (29%) patients, including four who underwent endovascular treatment, were discharged to hospice or deceased. No significant differences in modified Rankin Score improvement were observed between the endovascular and medical management groups at discharge (p = 0.96), at 30 days (p = 0.63), or at 90 days (p = 0.96).
CONCLUSIONS: Our analysis shows that revascularization therapy is a safe treatment, but it was not associated with improved functional status in nonagenarians with acute ischemic stroke. Endovascular therapy shows promise, and larger prospective studies are necessary to assess the benefits of revascularization therapy in the elderly population.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia - 78(2020) vom: 22. Aug., Seite 207-210 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Caruso, James P [VerfasserIn] |
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| Links: |
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| Themen: |
Elderly |
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| Anmerkungen: |
Date Completed 09.11.2020 Date Revised 09.11.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jocn.2020.04.060 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM309997771 |
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| 245 | 1 | 0 | |a Does endovascular therapy change outcomes in nonagenarians with acute ischemic stroke? |
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| 500 | |a Date Revised 09.11.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Ischemic strokes can be devastating for elderly patients, and randomized control trials of mechanical thrombectomy have shown encouraging results. We present the first analysis of clinical outcomes in nonagenarians with acute ischemic stroke treated with best medical therapy compared to endovascular revascularization therapy | ||
| 520 | |a METHODS: A retrospective analysis was performed on 42 patients 90 years or older who were treated for acute ischemic stroke. Modified Rankin scores were calculated immediately post-injury, at discharge, and at 30 days and 90 days following discharge. Student's t-test and Wald tests were performed to evaluate whether endovascular treatment was associated with modified Rankin Score improvement at discharge, 30 days, or 90 days after discharge | ||
| 520 | |a RESULTS: Follow-up data were available for 32/42 (76%) and 20/42 (48%) patients at 30 and 90 days after discharge, respectively. 8/9 (89%) patients who underwent endovascular treatment reached Thrombolysis in Cerebral Infarction scale 2b or better with no procedural complications. 12/42 (29%) patients, including four who underwent endovascular treatment, were discharged to hospice or deceased. No significant differences in modified Rankin Score improvement were observed between the endovascular and medical management groups at discharge (p = 0.96), at 30 days (p = 0.63), or at 90 days (p = 0.96) | ||
| 520 | |a CONCLUSIONS: Our analysis shows that revascularization therapy is a safe treatment, but it was not associated with improved functional status in nonagenarians with acute ischemic stroke. Endovascular therapy shows promise, and larger prospective studies are necessary to assess the benefits of revascularization therapy in the elderly population | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Elderly | |
| 650 | 4 | |a Endovascular | |
| 650 | 4 | |a Ischemic stroke | |
| 650 | 4 | |a Thrombectomy | |
| 700 | 1 | |a Wu, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Vance, Awais Z |e verfasserin |4 aut | |
| 700 | 1 | |a Olson, Daiwai |e verfasserin |4 aut | |
| 700 | 1 | |a Ban, Vin Shen |e verfasserin |4 aut | |
| 700 | 1 | |a El Ahmadieh, Tarek Y |e verfasserin |4 aut | |
| 700 | 1 | |a Aoun, Salah G |e verfasserin |4 aut | |
| 700 | 1 | |a Barr, John D |e verfasserin |4 aut | |
| 700 | 1 | |a Novakovic, Roberta |e verfasserin |4 aut | |
| 700 | 1 | |a Welch, Babu G |e verfasserin |4 aut | |
| 700 | 1 | |a White, Jonathan A |e verfasserin |4 aut | |
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