Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke

Jeremiah N. Johnson, Diogo C. Haussen, Mohamed Elhammady, Christine L. Pao, Dileep R Yavagal, Mohammad A. Aziz-Sultan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (=80 years) to non-elderly patients (<80 years) who underwent multimodality IAT. Methods From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged =80 years were compared to the patients <80 years. Results Between 2008 and 2012, 24 patients =80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p = <0.001) and atrial fibrillation (58.3% vs. 25.2%, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p = 0.17), THRIVE score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1% vs. 85.3%, p = 0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p = 0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7-16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1-2.40; p = 0.008) were independently associated with elderly age. Conclusion Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.

Original languageEnglish
Pages (from-to)136-141
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume123
DOIs
StatePublished - Jan 1 2014

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Stroke
Therapeutics
Safety
Atrial Fibrillation
Reperfusion
Registries
Hemorrhage
Mortality
Incidence

Keywords

  • Aged 80 and over
  • Endovascular procedures
  • Intra-arterial therapy
  • Mechanical thrombolysis
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke. / Johnson, Jeremiah N.; Haussen, Diogo C.; Elhammady, Mohamed; Pao, Christine L.; Yavagal, Dileep R; Aziz-Sultan, Mohammad A.

In: Clinical Neurology and Neurosurgery, Vol. 123, 01.01.2014, p. 136-141.

Research output: Contribution to journalArticle

Johnson, Jeremiah N. ; Haussen, Diogo C. ; Elhammady, Mohamed ; Pao, Christine L. ; Yavagal, Dileep R ; Aziz-Sultan, Mohammad A. / Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke. In: Clinical Neurology and Neurosurgery. 2014 ; Vol. 123. pp. 136-141.
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abstract = "Objective The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (=80 years) to non-elderly patients (<80 years) who underwent multimodality IAT. Methods From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged =80 years were compared to the patients <80 years. Results Between 2008 and 2012, 24 patients =80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7{\%} vs. 28.4{\%}, p = <0.001) and atrial fibrillation (58.3{\%} vs. 25.2{\%}, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p = 0.17), THRIVE score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1{\%} vs. 85.3{\%}, p = 0.13), or severe reperfusion hemorrhages (8.3{\%} vs. 4.2{\%}, p = 0.425). There was no significant difference in 3-month mortality (33.3{\%} vs. 16.8{\%}, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0{\%} vs. 40.0{\%}, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95{\%} CI 1.7-16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95{\%} CI 1.1-2.40; p = 0.008) were independently associated with elderly age. Conclusion Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.",
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AU - Johnson, Jeremiah N.

AU - Haussen, Diogo C.

AU - Elhammady, Mohamed

AU - Pao, Christine L.

AU - Yavagal, Dileep R

AU - Aziz-Sultan, Mohammad A.

PY - 2014/1/1

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N2 - Objective The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (=80 years) to non-elderly patients (<80 years) who underwent multimodality IAT. Methods From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged =80 years were compared to the patients <80 years. Results Between 2008 and 2012, 24 patients =80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p = <0.001) and atrial fibrillation (58.3% vs. 25.2%, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p = 0.17), THRIVE score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1% vs. 85.3%, p = 0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p = 0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7-16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1-2.40; p = 0.008) were independently associated with elderly age. Conclusion Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.

AB - Objective The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (=80 years) to non-elderly patients (<80 years) who underwent multimodality IAT. Methods From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged =80 years were compared to the patients <80 years. Results Between 2008 and 2012, 24 patients =80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p = <0.001) and atrial fibrillation (58.3% vs. 25.2%, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p = 0.17), THRIVE score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1% vs. 85.3%, p = 0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p = 0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7-16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1-2.40; p = 0.008) were independently associated with elderly age. Conclusion Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.

KW - Aged 80 and over

KW - Endovascular procedures

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