15. Predictive factors of good outcome in the elderly after recanalization treatments for anterior circulation

Mai Duy Ton, Dao Viet Phuong

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Abstract

The evaluation of prognostic factors related to a good outcome (mRS 0 - 2) after reperfusion therapy in patients ≥ 80 years of age is limited in Viet Nam. This study aimed to find out the rate and some factors related to the good outcome after 3 months. A cross-sectional retrospective study was conducted at the Bach Mai stroke center from November 2020 to May 2022; 83 elderly patients with acute ischemic stroke due to anterior circulation were treated with reperfusion treatments. There were 40 males (48.2%) and 43 females (51.8%) with median age 83 (IQR, 81 - 86), median baseline NIHSS score 13 (IQR, 9 - 16). The good outcome (mRS 0 - 2) rate was 37.3%. Multivariate regression logistics was used to figure out the predictors of good outcome after 3 months. Only a decrease in NIHSS score ≥ 4 points after 24 hours of reperfusion treatments was an independent prognostic factor of the good outcome.

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References

1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. New Engl J Med. 2018;378:11-21. doi: https://doi.org/10.1056/NEJMo a1706442.
2. Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med. 2019;380(19):1795-1803.
3. Powers WJ, Rabinstein AA, Ackerson T, et al. 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. 2019;50(12):e344-e418. doi: 10.1161/STR.0000000000000211.
4. Zeevi N, Kuchel GA, Lee NS, et al. Interventional Stroke Therapies in the Elderly: Are We Helping? Am J Neuroradiol. 2012;33(4):638-642. doi: 10.3174/ajnr.A2845.
5. Alawieh A, Chatterjee A, Feng W, et al. Thrombectomy for acute ischemic stroke in the elderly: a “real world” experience. J Neurointerventional Surg. 2018;10(12):1209-1217. doi: 10.1136/neurintsurg-2018-013787.
6. Viticchi G, Potente E, Falsetti L, et al. Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients. Neurol Sci. 2022;43(7):4323-4333. doi: 10.1007/s10072-022-05958-4.
7. Chamorro Á, Blasco J, López A, et al. Complete reperfusion is required for maximal benefits of mechanical thrombectomy in stroke patients. Sci Rep. 2017;7:11636. doi: 10.1038/s41598-017-11946-y.
8. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. doi: 10.1161/01.str.24.1.35.
9. von Kummer R, Broderick JP, Campbell BCV, et al. The Heidelberg Bleeding Classification: Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy. Stroke. 2015;46(10):2981-2986. doi: 10.1161/STROKEAHA.115.010049.
10. Sudre J, Venditti L, Ancelet C, et al. Reperfusion therapy for acute ischemic stroke in older people: An observational real-life study. J Am Geriatr Soc. 2021;69(11):3167-3176. doi: 10.1111/jgs.17394.
11. Bluhmki E, Danays T, Biegert G, et al. Alteplase for Acute Ischemic Stroke in Patients Aged >80 Years: Pooled Analyses of Individual Patient Data. Stroke. 2020;51(8):2322-2331. doi: 10.1161/STROKEAHA.119.028396.
12. Turc G, Tsivgoulis G, Audebert HJ, et al. European Stroke Organisation (ESO)-European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion. J Neurointerventional Surg. 2022;14(3):209. doi: 10.1136/neurintsurg-2021-018589.
13. Alawieh A, Starke RM, Chatterjee AR, et al. Outcomes of endovascular thrombectomy in the elderly: A “real-world” multicenter study. J Neurointerventional Surg. 2019;11(6):545-553. doi: 10.1136/neurintsurg-2018-014289.
14. Wang Q, Zhang YQ, Qiu HC, et al. Recanalization Treatment of Acute Ischemic Stroke Caused by Large-Artery Occlusion in the Elderly: A Comparative Analysis of “the Elderly” and “the Very Elderly.” Dis Markers. 2021;2021:3579074. doi: 10.1155/2021/3579074.