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Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke

  • Original Article - Vascular
  • Published:
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Abstract

Background

The average life expectancy is increasing worldwide, surpassing 80 years in some countries. Recently, mechanical thrombectomy (MT) using modern devices and techniques has led to improved clinical outcomes following acute ischemic stroke. However, thus far, it remains uncertain whether MT is effective in elderly patients aged over 80 years.

Methods

Between July 2013 and June 2016, 207 patients with acute ischemic stroke in the anterior circulation received MT at our center. The applied MT strategies were forced arterial suction thrombectomy (FAST) and stent retriever thrombectomy. Patients were divided into those <80 years (n = 173) and those ≥80 years (n = 34). We compared clinical and angiographic parameters between groups.

Results

The median age was 67.5 in the younger group and 82 in the elderly group; 92.5% of the younger group and 70.6% of the elderly group received MT via the FAST technique. Angiographic outcomes, including procedural time, mTICI 2b-3 reperfusion (85.5% vs. 82.4%, p = 0.633), and symptomatic intracranial hemorrhage, were not different between the groups. A favorable clinical outcome rate was significantly higher in the younger group (62.4% vs. 44.1%, p = 0.047). Younger age, a low NIHSS score, and fast onset to reperfusion time were favorable prognostic factors in elderly patients.

Conclusion

Modern MT in elderly patients with acute ischemic stroke is safe and effective compared to younger patients despite a lower favorable clinical outcome. Our findings may suggest that an appropriate MT strategy with respect to the location of the target occlusion and vascular tortuosity might be helpful to achieve fast reperfusion and improved outcomes for elderly patients.

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Acknowledgements

The authors appreciate Wade Martin of Emareye Medical Editing Services for critical English revision.

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Authors and Affiliations

  1. Department of Neurology, Jinju Hanil Hospital, Jinju, Republic of Korea

    Seungnam Son

  2. Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea

    Dong-Hun Kang

  3. Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea

    Dong-Hun Kang, Yong-Sun Kim & Yong-Won Kim

  4. School of Medicine, Kyungpook National University, Daegu, 130, Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea

    Dong-Hun Kang, Yang-Ha Hwang, Yong-Sun Kim & Yong-Won Kim

  5. Department of Neurology, Kyungpook National University Hospital, Daegu, Republic of Korea

    Yang-Ha Hwang & Yong-Won Kim

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  1. Seungnam Son
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Correspondence to Yong-Won Kim.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Comments

The authors clearly demonstrated that modern mechanical thrombectomy in elderly patients with acute ischemic stroke is safe and effective from their single-center experience. However, the favorable clinical outcome rate was significantly higher in the younger age group than in the elderly group. As they concluded, an appropriate strategy might be helpful to achieve fast reperfusion and improved outcomes for elderly patients.

Kenji Sugiu,

Okayama City, Japan

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Son, S., Kang, DH., Hwang, YH. et al. Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke. Acta Neurochir 159, 1663–1669 (2017). https://doi.org/10.1007/s00701-017-3269-y

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  • DOI: https://doi.org/10.1007/s00701-017-3269-y

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