Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly
Background Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 yea...
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| Veröffentlicht in: | Clinical neuroradiology (Munich) 2022-06, Vol.32 (2), p.369-374 |
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| creator | Hendrix, Philipp Killer-Oberpfalzer, Monika Broussalis, Erasmia Melamed, Itay Sharma, Vaibhav Mutzenbach, Sebastian Pikija, Slaven Collins, Malie Lieberman, Noah Hecker, Constantin Goren, Oded Zand, Ramin Schirmer, Clemens M. Trinka, Eugen Griessenauer, Christoph J. |
| description | Background
Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown.
Methods
Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged |
| doi_str_mv | 10.1007/s00062-021-01063-9 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2555638779</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A706798609</galeid><sourcerecordid>A706798609</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-eb0c46cf10aa8407ebdc978b748fdca7a0d4e5f13d773b3fea7702e78e726d3c3</originalsourceid><addsrcrecordid>eNp9kU9v1DAQxSMEolXpF-CALHHhkjKOkzg5rlYtVFq0BwpXy3HGuy6OXWxH1X57HLZ_BELIB4_Gv_c041cUbylcUAD-MQJAW5VQ0RIotKzsXxSntGv7ktY1f_lUs_6kOI_xNuPAur5p-OvihNWMMt53p4Xfzkn5CcmVt9bfG7cjX1DtpTNKWnKzD34aUCU_HYj2gaxcwmBysTZBzVYm4x3ZyLBD8h1jREu2Stk5Lu2vKfgfSIwjaY_k0o4Y7OFN8UpLG_H84T4rvl1d3qw_l5vtp-v1alOquq5SiQOoulWagpRdDRyHUfW8G3jd6VFJLmGssdGUjZyzgWmUnEOFvENetSNT7Kz4cPS9C_7njDGJyUSF1kqHfo6iapqmZR3nfUbf_4Xe-jm4PJ2oWt5Ax_oGnqmdtCiM0z4FqRZTseLQ5s9sYfG6-AeVz4iTUd6hNrn_h6A6ClTwMQbU4i6YSYaDoCCWoMUxaJGDFr-DFovo3cPE8zDh-CR5jDUD7AjE_OR2GJ5X-o_tL1lbsrs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2675083950</pqid></control><display><type>article</type><title>Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Hendrix, Philipp ; Killer-Oberpfalzer, Monika ; Broussalis, Erasmia ; Melamed, Itay ; Sharma, Vaibhav ; Mutzenbach, Sebastian ; Pikija, Slaven ; Collins, Malie ; Lieberman, Noah ; Hecker, Constantin ; Goren, Oded ; Zand, Ramin ; Schirmer, Clemens M. ; Trinka, Eugen ; Griessenauer, Christoph J.</creator><creatorcontrib>Hendrix, Philipp ; Killer-Oberpfalzer, Monika ; Broussalis, Erasmia ; Melamed, Itay ; Sharma, Vaibhav ; Mutzenbach, Sebastian ; Pikija, Slaven ; Collins, Malie ; Lieberman, Noah ; Hecker, Constantin ; Goren, Oded ; Zand, Ramin ; Schirmer, Clemens M. ; Trinka, Eugen ; Griessenauer, Christoph J.</creatorcontrib><description>Background
Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown.
Methods
Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80–89 years, and 90–99 years. Favorable functional outcome was defined as mRS 0–2 or reaching the prestroke mRS and moderate as mRS 0–3.
Results
The final data set comprised a total of 736 cases. Of these, 466 aged < 80 years, 219 aged 80–89 years, and 51 aged 90–99 years. In nonagenarians, TICI 2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80–89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80 years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively,
p
< 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%,
p
= 0.112–0.211).
Conclusion
A moderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.</description><identifier>ISSN: 1869-1439</identifier><identifier>EISSN: 1869-1447</identifier><identifier>DOI: 10.1007/s00062-021-01063-9</identifier><identifier>PMID: 34313798</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age groups ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases ; Brain Ischemia - therapy ; Cardiac arrhythmia ; Cardiovascular disease ; Clinical trials ; Diabetes ; Hemorrhage ; Humans ; Information sharing ; Intracranial Hemorrhages ; Ischemia ; Ischemic Stroke ; Medicine ; Medicine & Public Health ; Mortality ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Original Article ; Retrospective Studies ; Stroke ; Stroke (Disease) ; Thrombectomy ; Treatment Outcome ; Type 2 diabetes</subject><ispartof>Clinical neuroradiology (Munich), 2022-06, Vol.32 (2), p.369-374</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2021</rights><rights>2021. Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>COPYRIGHT 2022 Springer</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-eb0c46cf10aa8407ebdc978b748fdca7a0d4e5f13d773b3fea7702e78e726d3c3</citedby><cites>FETCH-LOGICAL-c442t-eb0c46cf10aa8407ebdc978b748fdca7a0d4e5f13d773b3fea7702e78e726d3c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00062-021-01063-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00062-021-01063-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34313798$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hendrix, Philipp</creatorcontrib><creatorcontrib>Killer-Oberpfalzer, Monika</creatorcontrib><creatorcontrib>Broussalis, Erasmia</creatorcontrib><creatorcontrib>Melamed, Itay</creatorcontrib><creatorcontrib>Sharma, Vaibhav</creatorcontrib><creatorcontrib>Mutzenbach, Sebastian</creatorcontrib><creatorcontrib>Pikija, Slaven</creatorcontrib><creatorcontrib>Collins, Malie</creatorcontrib><creatorcontrib>Lieberman, Noah</creatorcontrib><creatorcontrib>Hecker, Constantin</creatorcontrib><creatorcontrib>Goren, Oded</creatorcontrib><creatorcontrib>Zand, Ramin</creatorcontrib><creatorcontrib>Schirmer, Clemens M.</creatorcontrib><creatorcontrib>Trinka, Eugen</creatorcontrib><creatorcontrib>Griessenauer, Christoph J.</creatorcontrib><title>Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly</title><title>Clinical neuroradiology (Munich)</title><addtitle>Clin Neuroradiol</addtitle><addtitle>Clin Neuroradiol</addtitle><description>Background
Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown.
Methods
Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80–89 years, and 90–99 years. Favorable functional outcome was defined as mRS 0–2 or reaching the prestroke mRS and moderate as mRS 0–3.
Results
The final data set comprised a total of 736 cases. Of these, 466 aged < 80 years, 219 aged 80–89 years, and 51 aged 90–99 years. In nonagenarians, TICI 2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80–89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80 years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively,
p
< 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%,
p
= 0.112–0.211).
Conclusion
A moderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.</description><subject>Age groups</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial Occlusive Diseases</subject><subject>Brain Ischemia - therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Diabetes</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Information sharing</subject><subject>Intracranial Hemorrhages</subject><subject>Ischemia</subject><subject>Ischemic Stroke</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>Stroke (Disease)</subject><subject>Thrombectomy</subject><subject>Treatment Outcome</subject><subject>Type 2 diabetes</subject><issn>1869-1439</issn><issn>1869-1447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU9v1DAQxSMEolXpF-CALHHhkjKOkzg5rlYtVFq0BwpXy3HGuy6OXWxH1X57HLZ_BELIB4_Gv_c041cUbylcUAD-MQJAW5VQ0RIotKzsXxSntGv7ktY1f_lUs_6kOI_xNuPAur5p-OvihNWMMt53p4Xfzkn5CcmVt9bfG7cjX1DtpTNKWnKzD34aUCU_HYj2gaxcwmBysTZBzVYm4x3ZyLBD8h1jREu2Stk5Lu2vKfgfSIwjaY_k0o4Y7OFN8UpLG_H84T4rvl1d3qw_l5vtp-v1alOquq5SiQOoulWagpRdDRyHUfW8G3jd6VFJLmGssdGUjZyzgWmUnEOFvENetSNT7Kz4cPS9C_7njDGJyUSF1kqHfo6iapqmZR3nfUbf_4Xe-jm4PJ2oWt5Ax_oGnqmdtCiM0z4FqRZTseLQ5s9sYfG6-AeVz4iTUd6hNrn_h6A6ClTwMQbU4i6YSYaDoCCWoMUxaJGDFr-DFovo3cPE8zDh-CR5jDUD7AjE_OR2GJ5X-o_tL1lbsrs</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Hendrix, Philipp</creator><creator>Killer-Oberpfalzer, Monika</creator><creator>Broussalis, Erasmia</creator><creator>Melamed, Itay</creator><creator>Sharma, Vaibhav</creator><creator>Mutzenbach, Sebastian</creator><creator>Pikija, Slaven</creator><creator>Collins, Malie</creator><creator>Lieberman, Noah</creator><creator>Hecker, Constantin</creator><creator>Goren, Oded</creator><creator>Zand, Ramin</creator><creator>Schirmer, Clemens M.</creator><creator>Trinka, Eugen</creator><creator>Griessenauer, Christoph J.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20220601</creationdate><title>Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly</title><author>Hendrix, Philipp ; Killer-Oberpfalzer, Monika ; Broussalis, Erasmia ; Melamed, Itay ; Sharma, Vaibhav ; Mutzenbach, Sebastian ; Pikija, Slaven ; Collins, Malie ; Lieberman, Noah ; Hecker, Constantin ; Goren, Oded ; Zand, Ramin ; Schirmer, Clemens M. ; Trinka, Eugen ; Griessenauer, Christoph J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-eb0c46cf10aa8407ebdc978b748fdca7a0d4e5f13d773b3fea7702e78e726d3c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age groups</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial Occlusive Diseases</topic><topic>Brain Ischemia - therapy</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Diabetes</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Information sharing</topic><topic>Intracranial Hemorrhages</topic><topic>Ischemia</topic><topic>Ischemic Stroke</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Retrospective Studies</topic><topic>Stroke</topic><topic>Stroke (Disease)</topic><topic>Thrombectomy</topic><topic>Treatment Outcome</topic><topic>Type 2 diabetes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hendrix, Philipp</creatorcontrib><creatorcontrib>Killer-Oberpfalzer, Monika</creatorcontrib><creatorcontrib>Broussalis, Erasmia</creatorcontrib><creatorcontrib>Melamed, Itay</creatorcontrib><creatorcontrib>Sharma, Vaibhav</creatorcontrib><creatorcontrib>Mutzenbach, Sebastian</creatorcontrib><creatorcontrib>Pikija, Slaven</creatorcontrib><creatorcontrib>Collins, Malie</creatorcontrib><creatorcontrib>Lieberman, Noah</creatorcontrib><creatorcontrib>Hecker, Constantin</creatorcontrib><creatorcontrib>Goren, Oded</creatorcontrib><creatorcontrib>Zand, Ramin</creatorcontrib><creatorcontrib>Schirmer, Clemens M.</creatorcontrib><creatorcontrib>Trinka, Eugen</creatorcontrib><creatorcontrib>Griessenauer, Christoph J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neuroradiology (Munich)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hendrix, Philipp</au><au>Killer-Oberpfalzer, Monika</au><au>Broussalis, Erasmia</au><au>Melamed, Itay</au><au>Sharma, Vaibhav</au><au>Mutzenbach, Sebastian</au><au>Pikija, Slaven</au><au>Collins, Malie</au><au>Lieberman, Noah</au><au>Hecker, Constantin</au><au>Goren, Oded</au><au>Zand, Ramin</au><au>Schirmer, Clemens M.</au><au>Trinka, Eugen</au><au>Griessenauer, Christoph J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly</atitle><jtitle>Clinical neuroradiology (Munich)</jtitle><stitle>Clin Neuroradiol</stitle><addtitle>Clin Neuroradiol</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>32</volume><issue>2</issue><spage>369</spage><epage>374</epage><pages>369-374</pages><issn>1869-1439</issn><eissn>1869-1447</eissn><abstract>Background
Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown.
Methods
Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80–89 years, and 90–99 years. Favorable functional outcome was defined as mRS 0–2 or reaching the prestroke mRS and moderate as mRS 0–3.
Results
The final data set comprised a total of 736 cases. Of these, 466 aged < 80 years, 219 aged 80–89 years, and 51 aged 90–99 years. In nonagenarians, TICI 2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80–89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80 years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively,
p
< 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%,
p
= 0.112–0.211).
Conclusion
A moderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34313798</pmid><doi>10.1007/s00062-021-01063-9</doi><tpages>6</tpages></addata></record> |
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| subjects | Age groups Aged Aged, 80 and over Arterial Occlusive Diseases Brain Ischemia - therapy Cardiac arrhythmia Cardiovascular disease Clinical trials Diabetes Hemorrhage Humans Information sharing Intracranial Hemorrhages Ischemia Ischemic Stroke Medicine Medicine & Public Health Mortality Neurology Neuroradiology Neurosciences Neurosurgery Original Article Retrospective Studies Stroke Stroke (Disease) Thrombectomy Treatment Outcome Type 2 diabetes |
| title | Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly |
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