Journal of Korean Neurosurgical Society

  • 제60권6호
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  • Pages.654-660
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  • 2017
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Significances and Outcomes of Mechanical Thrombectomy for Acute Infarction in Very Elderly Patients : A Single Center Experience

  • Kim, Dong Hun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sang Uk (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dong Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yi, Ho Jun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2016.12.23
  • 심사 : 2017.09.30
  • 발행 : 2017.11.01
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초록

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

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피인용 문헌

  1. Thrombectomy for acute ischemic stroke in the elderly: a ‘real world’ experience vol.10, pp.12, 2018, https://doi.org/10.1136/neurintsurg-2018-013787
  2. Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study vol.11, pp.6, 2019, https://doi.org/10.1136/neurintsurg-2018-014289
  3. Using machine learning to optimize selection of elderly patients for endovascular thrombectomy vol.11, pp.8, 2019, https://doi.org/10.1136/neurintsurg-2018-014381
  4. Predictors of discharge outcomes following percutaneous mechanical thrombectomy in patients with acute ischemic stroke: Comparisons between the home discharge group and hospital transfer group vol.33, pp.1, 2017, https://doi.org/10.15369/sujms.33.9
  5. Predictors of home discharge after mechanical thrombectomy in patients with acute ischemic stroke: Usefulness of National Institutes of Health Stroke Scale sub-items assessed 24 h postoperatively vol.26, pp.None, 2017, https://doi.org/10.1016/j.inat.2021.101341