Endovascular thrombectomy for acute ischaemic stroke improves and maintains function in the very elderly: A multicentre propensity score matched analysis

Author:

Dunphy Harriette1,Garcia-Esperon Carlos23,Beom Hong Jae4,Manoczki Csilla5,Wilson Duncan16,Lim Alvin Chew Beng2,Beharry James1,Bivard Andrew2,Hasnain Md Golam3,Krauss Martin7,Collecutt Wayne7,Miteff Ferdi2,Spratt Neil238,Parsons Mark W29,Alan Barber Peter410,Ranta Annemarei511,Fink John N1,Wu Teddy Y1612ORCID

Affiliation:

1. Department of Neurology, Christchurch Hospital, Christchurch, New Zealand

2. Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia

3. Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia

4. Department of Neurology, Auckland City Hospital, Auckland, New Zealand

5. Department of Neurology, Wellington Hospital, University of Otago, Wellington, New Zealand

6. New Zealand Brain Research Institute, Christchurch, New Zealand

7. Department of Radiology, Christchurch Hospital, New Zealand

8. The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, NSW, Australia

9. University of New South Wales South Western Sydney Clinical Campus, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

10. Centre for Brain Research, University of Auckland, Auckland, New Zealand

11. Department of Medicine, University of Otago, Wellington, New Zealand

12. Department of Medicine, University of Otago, Christchurch, New Zealand

Abstract

Introduction: The very elderly (⩾80 years) are under-represented in randomised endovascular thrombectomy (EVT) clinical trials for acute ischaemic stroke. Rates of independent outcome in this group are generally lower than the less-old patients but the comparisons may be biased by an imbalance of non-age related baseline characteristics, treatment related metrics and medical risk factors. Patients and methods: We compared outcomes between very elderly (⩾80) and the less-old (<80 years) using retrospective data from consecutive patients receiving EVT from four comprehensive stroke centres in New Zealand and Australia. We used propensity score matching or multivariable logistic regression to account for confounders. Results: We included 600 patients (300 in each age cohort) after propensity score matching from an initial group of 1270 patients. The median baseline National Institutes of Health Stroke Scale was 16 (11–21), with 455 (75.8%) having symptom free pre-stroke independent function, and 268 (44.7%) receiving intravenous thrombolysis. Good functional outcome (90-day modified Rankin Scale 0–2) was achieved in 282 (46.8%), with very elderly patients having less proportion of good outcome compared to the less-old (118 (39.3%) vs 163 (54.3%), p < 0.01). There was no difference between the very elderly and the less-old in the proportion of patients who returned to baseline function at 90 days (56 (18.7%) vs 62 (20.7%), p = 0.54). All-cause 90-day mortality was higher in the very elderly (75 (25%) vs 49 (16.3%), p < 0.01), without a difference in symptomatic haemorrhage (very elderly 11 (3.7%) vs 6 (2.0%), p = 0.33). In the multivariable logistic regression models, the very elderly were significantly associated with reduced odds of good 90-day outcome (OR 0.49, 95% CI 0.34–0.69, p < 0.01) but not with return to baseline function (OR 0.85, 90% CI 0.54–1.29, p = 0.45) after adjusting for confounders. Conclusion: Endovascular thrombectomy can be successfully and safely performed in the very elderly. Despite an increase in all-cause 90-day mortality, selected very elderly patients are as likely as younger patients with similar baseline characteristics to return to baseline function following EVT.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

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