Prognostic determinants of anterior large vessel occlusion in acute stroke in elderly patients

Abstract

AbstractIntroductionMechanical thrombectomy(MT) has been shown to be safety and effectiveness for acute anterior circulation large vessel occlusion(LVO)of all ages, and together with intravenous thrombolysis has become an standard treatment for acute stroke. In an aging world, the effectiveness of MT for the elderly has not been fully demonstrated. We investigated factors associated with prognosis in elderly patients undergoing MT in Japanese practice, where the elderly are defined as those aged 80 years or older, in the context of an ageing population.MethodMT was performed in 59 cases of LVO of the anterior circulation. Primary outcome evaluated functional outcome at three months. Parametric and/or non-parametric test and a binomial logistic regression model was performed to identify prognosis factors in elderly patients.ResultsOverall, Of the 59 patients, 47.5% (28/59) achieved an mRS ≤3 at 3 months. Mortality rate was 20.3% (12/59). Younger age(P=0.032), lower NIHSS on admission(P=0.00005), lower level of NT-proBNP on admission(P=0.041), lower level of D-dimer on admission(P=0.01), First Pass Effect (FPE) (P=0.024) and good recanalization(P=0.0025) were associated with favorable clinical outcome. In the binomial logistic regression model, only lower NIHSS on admission was significantly associated with good clinical outcome.ConclusionsIn the present study, not only were younger age, lower NIHSS on admission and FPE already reported as prognostic factors for MT for LVO in the elderly, but also, although not previously reported, lower levels of NT-proBNP on admission and lower level of D-dimer on admission were considered as possible prognostic factors.