Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Predictors of Catastrophic Outcome after Endovascular Thrombectomy in Elderly Patients with Acute Anterior Circulation Stroke

  • Younsu Ahn (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Seul Kee Kim (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Byung Hyun Baek (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Yun Young Lee (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Hyo-jae Lee (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital) ;
  • Woong Yoon (Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital)
  • Received : 2019.06.17
  • Accepted : 2019.08.22
  • Published : 2020.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: Avoiding a catastrophic outcome may be a more realistic goal than achieving functional independence in the treatment of acute stroke in octogenarians. This study aimed to investigate predictors of catastrophic outcome in elderly patients after an endovascular thrombectomy with an acute anterior circulation large vessel occlusion (LVO). Materials and Methods: Data from 82 patients aged ≥ 80 years, who were treated with thrombectomy for acute anterior circulation LVO, were analyzed. The association between clinical/imaging variables and catastrophic outcomes was assessed. A catastrophic outcome was defined as a modified Rankin Scale score of 4-6 at 90 days. Results: Successful reperfusion was achieved in 61 patients (74.4%), while 47 patients (57.3%) had a catastrophic outcome. The 90-day mortality rate of the treated patients was 15.9% (13/82). The catastrophic outcome group had a significantly lower baseline diffusion-weighted imaging-Alberta stroke program early CT score (DWI-ASPECTS) (7 vs. 8, p = 0.014) and a longer procedure time (42 minutes vs. 29 minutes, p = 0.031) compared to the non-catastrophic outcome group. Successful reperfusion was significantly less frequent in the catastrophic outcome group (63.8% vs. 88.6%, p = 0.011) compared to the non-catastrophic outcome group. In a binary logistic regression analysis, DWI-ASPECTS (odds ratio [OR], 0.709; 95% confidence interval [CI], 0.524-0.960; p = 0.026) and successful reperfusion (OR, 0.242; 95% CI, 0.071-0.822; p = 0.023) were independent predictors of a catastrophic outcome. Conclusion: Baseline infarct size and reperfusion status were independently associated with a catastrophic outcome after endovascular thrombectomy in elderly patients aged ≥ 80 years with acute anterior circulation LVO.

Keywords

References

  1. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al.; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a metaanalysis of individual patient data from five randomised trials. Lancet 2016;387:1723-1731
  2. Alawieh A, Starke RM, Chatterjee AR, Turk A, De Leacy R, Rai AT, et al. Outcomes of endovascular thrombectomy in the elderly: a 'real-world' multicenter study. J Neurointerv Surg 2019;11:545-553
  3. Chandra RV, Leslie-Mazwi TM, Mehta BP, Yoo AJ, Simonsen CZ. Clinical outcome after intra-arterial stroke therapy in the very elderly: why is it so heterogeneous? Front Neurol 2014;5:60
  4. Cohen JE, Gomori JM, Leker RR. Stent retriever-based thrombectomy in octogenarians. Interv Neurol 2016;5:111-117
  5. Hilditch CA, Nicholson P, Murad MH, Rabinstein A, Schaafsma J, Pikula A, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2018;39:887-891
  6. Neugebauer H, Creutzfeldt CJ, Hemphill JC 3rd, Heuschmann PU, Juttler E. DESTINY-S: attitudes of physicians toward disability and treatment in malignant MCA infarction. Neurocrit Care 2014;21:27-34
  7. Kurre W, Aguilar-Perez M, Niehaus L, Fischer S, Schmid E, Bazner H, et al. Predictors of outcome after mechanical thrombectomy for anterior circulation large vessel occlusion in patients aged ≥80 years. Cerebrovasc Dis 2013;36:430-436
  8. Lima A, Haussen DC, Rebello LC, Dehkharghani S, Grossberg J, Grigoryan M, et al. Endovascular therapy for large vessel stroke in the elderly: hope in the new stroke era. Cerebrovasc Dis 2016;42:421-427
  9. Koizumi S, Ota T, Shigeta K, Amano T, Ueda M, Matsumaru Y, et al. Onset to reperfusion time was not important in mechanical thrombectomy for elderly patients: a retrospective multicenter study in Tama area, Tokyo. Cerebrovasc Dis 2018;46:89-96
  10. Barral M, Lassalle L, Dargazanli C, Mazighi M, Redjem H, Blanc R, et al. Predictors of favorable outcome after mechanical thrombectomy for anterior circulation acute ischemic stroke in octogenarians. J Neuroradiol 2018;45:211-216
  11. Slawski DE, Salahuddin H, Shawver J, Kenmuir CL, Tietjen GE, Korsnack A, et al. Mechanical thrombectomy in elderly stroke patients with mild-to-moderate baseline disability. Interv Neurol 2018;7:246-255
  12. Yoon W, Kim SK, Park MS, Baek BH, Lee YY. Predictive factors for good outcome and mortality after stent-retriever thrombectomy in patients with acute anterior circulation stroke. J Stroke 2017;19:97-103
  13. Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al.; Cerebral Angiographic Revascularization Grading (CARG) Collaborators; STIR Revascularization working group; STIR Thrombolysis in Cerebral Infarction (TICI) Task Force. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 2013;44:2650-2663
  14. Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery 2015;76:680-686
  15. Larrue V, von Kummer R, Muller A, Bluhmki E. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 2001;32:438-441
  16. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, 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;24:35-41
  17. Mokin M, Ansari SA, McTaggart RA, Bulsara KR, Goyal M, Chen M, et al.; Society of NeuroInterventional Surgery. Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS standards and guidelines committee. J Neurointerv Surg 2019;11:215-220
  18. Jayaraman MV, McTaggart RA. Endovascular treatment of anterior circulation large vessel occlusion in the elderly. Front Neurol 2018;8:713
  19. Imahori T, Tanaka K, Arai A, Shiomi R, Fujiwara D, Mori T, et al. Mechanical thrombectomy for acute ischemic stroke patients aged 80 years or older. J Stroke Cerebrovasc Dis 2017;26:2793-2799
  20. Ribo M, Flores A, Mansilla E, Rubiera M, Tomasello A, Coscojuela P, et al. Age-adjusted infarct volume threshold for good outcome after endovascular treatment. J Neurointerv Surg 2014;6:418-422
  21. Daniere F, Lobotesis K, Machi P, Eker O, Mourand I, Riquelme C, et al. Patient selection for stroke endovascular therapy--DWIASPECTS thresholds should vary among age groups: insights from the RECOST study. AJNR Am J Neuroradiol 2015;36:32-39
  22. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al.; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21