Comparison of mechanical thrombectomy for patients with acute ischemic stroke over 85 years and younger: A Single Center Experience

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  • Komatsubara Koichiro
    Department of Neurosurgery, Kugayama hospital
  • Abe Yasuaki
    Department of Neurosurgery, Kugayama hospital
  • Nitta Yusuke
    Department of Neurosurgery, Kugayama hospital, (current affiliation: Department of Neurosurgery, Tokorozawa central hospital)
  • Fujitsuka Mitsuyuki
    Department of Neurosurgery, Kugayama hospital Kachidoki neurosurgery

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Other Title
  • 都内地域中規模病院における高齢者に対する経皮的血栓回収療法
  • トナイ チイキ チュウキボ ビョウイン ニ オケル コウレイシャ ニ タイスル ケイヒテキ ケッセン カイシュウ リョウホウ

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Abstract

<p>  Several recent reports have described the efficacy of mechanical thrombectomy for patient with acute ischemic stroke. However, the efficacy of mechanical thrombectomy for the elderly has not been analyzed sufficiently. Here, we evaluated outcomes in elderly patients at a regional core hospital. Between February 2017 and August 2019, 30 patients (14 males, 16 females; average age, 81.1±11.4 years) with intracranial acute large vessel occlusion, were treated with mechanical thrombectomy at our institute. We compared outcomes between patients ≧ 85 years old (n＝13) and those＜85 years old (n＝17), and assessed prognostic factors for favorable outcomes (90‒day modified Rankin Scale (mRS) scores of 0‒2) at 90 days in all patients. There was no significant difference in Successful recanalization (Thrombolysis in Cerebral infarction [TICI] score2b/3) (76.5% versus 69.2%) between the 2 gropes. Favorable outcomes (0% versus 52.9%, P＝.003) were achieved more often in those＜85 years old. Univariate regression analysis showed that age, hypertension, NIHSS at onset, pre‒symptomatic mRS, onset to door time, puncture to lesion arrival time, puncture to recanalization time, type of cerebral infarction were significant predictive factors. The clinical outcomes of the elderly in the present study were not as good as those of the non‒elderly. Elderly patients tend to have low pre‒symptomatic mRS scores and many underlying diseases, so not only is prompt and effective recanalization required, but also their rehabilitation and nursing after treatment require more human resources than for non‒elderly people. Conclusion: It is necessary to carefully judge treatment indications based on these issues for regional core hospitals.</p>

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