Acute Recanalization of Large Vessel Occlusion in the Anterior Circulation Stroke: Is Mechanical Thrombectomy Alone Better in Patients over 80 Years of Age? Findings from a Retrospective Observational Study
Status PubMed-not-MEDLINE Jazyk angličtina Země Švýcarsko Médium electronic
Typ dokumentu časopisecké články
Grantová podpora
DRO-UHHK 00179906
Ministerstvo Zdravotnictví Ceské Republiky
PROGRES Q40
Univerzita Karlova v Praze
PubMed
34575377
PubMed Central
PMC8468316
DOI
10.3390/jcm10184266
PII: jcm10184266
Knihovny.cz E-zdroje
- Klíčová slova
- acute ischemic stroke, anterior circulation, bridging therapy, clinical outcome, elderly patients, intravenous thrombolysis, large vessel occlusion, mechanical thrombectomy, recanalization,
- Publikační typ
- časopisecké články MeSH
Real-world data report worse 3-month clinical outcomes in elderly patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). The aim was to identify factors influencing clinical outcome in elderly patients with anterior circulation AIS treated with MT (±intravenous thrombolysis (IVT)). In a retrospective, monocentric study, analysis of prospectively collected data of 138 patients (≥80 years) was performed. IVT was an independent negative predictor (OR 0.356; 95% CI: 0.134-0.942) and female sex an independent positive predictor (OR 4.179, 95% CI: 1.300-13.438) of 3-month good clinical outcome (modified Rankin scale 0-2). Female sex was also an independent negative predictor of 3-month mortality (OR 0.244, 95% CI: 0.100-0.599). Other independent negative predictors of 3-month good clinical outcome were older age, lower pre-stroke self-sufficiency, more severe neurological deficit and longer procedural intervals. Mortality was also independently predicted by longer procedural interval and by the occurrence of symptomatic intracerebral hemorrhage (p < 0.05 in all cases). Our results demonstrated, that in patients aged ≥80 years with anterior circulation AIS undergoing MT (±IVT), IVT reduced the chance of 3-month good clinical outcome and female sex was associated with a greater likelihood of 3-month good clinical outcome and lower probability of 3-month mortality.
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Berkhemer O.A., Fransen P.S.S., Beumer D., Van den Berg L.A., Lingsma H.F., Yoo A.J., Schonewille W.J., Vos J.A., Nederkoorn P.J., Wermer M.J.H., et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N. Engl. J. Med. 2015;372:11–20. doi: 10.1056/NEJMoa1411587. PubMed DOI
Campbell B.C., Mitchell P.J., Kleinig T., Dewey H.M., Churilov L., Yassi N., Yan B., Dowling R.J., Parsons M.W., Oxley T.J., et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N. Engl. J. Med. 2015;372:1009–1018. doi: 10.1056/NEJMoa1414792. PubMed DOI
Goyal M., Demchuk A.M., Menon B.K., Eesa M., Rempel J.L., Thornton J., Roy D., Jovin T.G., Willinsky R.A., Sapkota B.L., et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N. Engl. J. Med. 2015;372:1019–1030. doi: 10.1056/NEJMoa1414905. PubMed DOI
Saver J.L., Goyal M., Bonafe A., Diener H.-C., Levy E.I., Pereira V.M., Albers G.W., Cognard C., Cohen D.J., Hacke W., et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N. Engl. J. Med. 2015;372:2285–2295. doi: 10.1056/NEJMoa1415061. PubMed DOI
Jovin T.G., Chamorro A., Cobo E., De Miquel M.A., Molina C.A., Rovira A., Román L.S., Serena J., Abilleira S., Ribo M., et al. Thrombectomy within 8 h after symptom onset in ischemic stroke. N. Engl. J. Med. 2015;372:2296–2306. doi: 10.1056/NEJMoa1503780. PubMed DOI
Powers W.J., Rabinstein A.A., Ackerson T., Adeoye O.M., Bambakidis N.C., Becker K., Biller J., Brown M., Demaerschalk B.M., Hoh B., et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46–e110. doi: 10.1161/STR.0000000000000158. PubMed DOI
Šaňák D., Mikulík R., Tomek A., Bar M., Herzig R., Neumann J., Škoda O., Školoudík D., Václavík D., Roček M., et al. Doporučení pro mechanickou trombektomii akutního mozkového infarktu—Verze 2019. Cesk. Slov. Neurol. N. 2019;82/115:700–705. doi: 10.14735/amcsnn2019700. DOI
Leker R.R., Pikis S., Gomori J.M., Cohen J.E. Is bridging necessary? A pilot study of bridging versus primary stentretriever-based endovascular reperfusion in large anterior circulation strokes. J. Stroke Cerebrovasc. Dis. 2015;24:1163–1167. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.008. PubMed DOI
Broeg-Morvay A., Mordasini P., Bernasconi C., Bühlmann M., Pult F., Arnold M., Schroth G., Jung S., Mattle H.P., Gralla J., et al. Direct mechanical intervention versus combined intravenous and mechanical intervention in large anterior circulation stroke: A matched-pairs analysis. Stroke. 2016;47:1037–1044. doi: 10.1161/STROKEAHA.115.011134. PubMed DOI
Tsivgoulis G., Katsanos A.H., Mavridis D., Magoufis G., Arthur A., Alexandrov A.V. Mechanical thrombectomy improves functional outcomes independent of pretreatment with intravenous thrombolysis. Stroke. 2016;47:1661–1664. doi: 10.1161/STROKEAHA.116.013097. PubMed DOI
Coutinho J.M., Liebeskind D.S., Slater L.A., Nogueira R.G., Clark W., Dávalos A., Bonafé A., Jahan R., Fischer U., Gralla J., et al. Combined intravenous thrombolysis and thrombectomy vs. thrombectomy alone for acute ischemic stroke: A pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017;74:268–274. doi: 10.1001/jamaneurol.2016.5374. PubMed DOI
12. Abilleira S., Ribera A., Cardona P., Rubiera M., López-Cancio E., Amaro S., Rodríguez-Campello A., Camps-Renom P., Cánovas D., De Miquel M.A., et al. Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different. Stroke. 2017;48:375–378. doi: 10.1161/STROKEAHA.116.015857. PubMed DOI
Fischer U., Kaesmacher J., Pereira V.M., Chapot R., Siddiqui A.H., Froehler M.T., Cognard C., Furlan A.J., Saver J.L., Gralla J. Direct mechanical thrombectomy versus combined intravenous and mechanical thrombectomy in large-artery anterior circulation stroke: A topical review. Stroke. 2017;48:2912–2918. doi: 10.1161/STROKEAHA.117.017208. PubMed DOI
Bellwald S., Weber R., Dobrocky T., Nordmeyer H., Jung S., Hadisurya J., Mordasini P., Mono M.L., Stracke C.P., Sarikaya H., et al. Direct mechanical intervention versus bridging therapy in stroke patients eligible for intravenous thrombolysis: A pooled analysis of 2 registries. Stroke. 2017;48:3282–3288. doi: 10.1161/STROKEAHA.117.018459. PubMed DOI
Rai A.T., Boo S., Buseman C., Adcock A.K., Tarabishy A.R., Miller M.M., Roberts T.D., Domico J.R., Carpenter J.S. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J. Neurointerv. Surg. 2018;10:17–21. doi: 10.1136/neurintsurg-2016-012830.. PubMed DOI PMC
Malhotra A., Wu X., Payabvash S., Matouk C.C., Forman H.P., Gandhi D., Sanelli P., Schindler J. Comparative effectiveness of endovascular thrombectomy in elderly stroke patients. Stroke. 2019;50:963–969. doi: 10.1161/STROKEAHA.119.025031. PubMed DOI
Chandra R.V., Leslie-Mazwi T.M., Oh D.C., Chaudhry Z.A., Mehta B.P., Rost N.S., Rabinov J.D., Hirsch J.A., González R.G., Schwamm L.H., et al. Elderly patients are at higher risk for poor outcomes after intra-arterial therapy. Stroke. 2012;43:2356–2361. doi: 10.1161/STROKEAHA.112.650713. PubMed DOI
Goyal M., Menon B.K., Van Zwam W.H., Dippel D.W., Mitchell P.J., Demchuk A.M., Dávalos A., Majoie C.B., Van der Lugt A., De Miquel M.A., et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A-meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–1731. doi: 10.1016/S0140-6736(16)00163-X. PubMed DOI
Mueller-Kronast B.K., Zaidat O.O., Froehler M.T., Jahan R., Aziz-Sultan M.A., Klucznik R.P., Saver J.L., Hellinger F.R., Yavagal D.R., Yao T.L., et al. Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke: Primary results of the STRATIS registry. Stroke. 2017;48:2760–2768. doi: 10.1161/STROKEAHA.117.016456. PubMed DOI
Binning M.J., Bartolini B., Baxter B., Budzik R., English J., Gupta R., Hedayat H., Krajina A., Liebeskind D., Nogueira R.G., et al. Trevo 2000: Results of a large real-world registry for stent retriever for acute ischemic stroke. J. Am. Heart Assoc. 2018;7:e010867. doi: 10.1161/JAHA.118.010867. PubMed DOI PMC
Alawieh A., Chatterjee A., Feng W., Porto G., Vargas J., Kellogg R., Turk A.S., Turner R.D., Chaudry M.I., Spiotta A.M. Thrombectomy for acute ischemic stroke in the elderly: A ‘real world’ experience. J. Neurointerv. Surg. 2018;10:1209–1217. doi: 10.1136/neurintsurg-2018-013787. PubMed DOI
Sharobeam A., Cordato D.J., Manning N., Cheung A., Wenderoth J., Cappelen-Smith C. Functional outcomes at 90 days in octogerians undergoing thrombectomy for acute ischemic stroke: A prospective cohort study and meta-analysis. Front. Neurol. 2019;10:254. doi: 10.3389/fneur.2019.00254. PubMed DOI PMC
Wollenweber F.A., Tiedt S., Alegiani A., Alber B., Bangard C., Berrouschot J., Bode F.J., Boeckh-Behrens T., Bohner G., Bormann A., et al. Functional outcome following stroke thrombectomy in clinical practice. Stroke. 2019;50:2500–2506. doi: 10.1161/STROKEAHA.119.026005. PubMed DOI
Martini M., Mocco J., Turk A., Siddiqui A.H., Fiorella D., Hanel R., Woodward K., Rai A., Frei D., Almandoz J.E.D., et al. An international multicenter retrospective study to survey the landscape of thrombectomy in the treatment of anterior circulaton acute ischemic stroke: Outcomes with respect to age. J. Neurointerv. Surg. 2020;12:115–121. doi: 10.1136/neurintsurg-2019-015093. PubMed DOI
Adams H.P., Del Zoppo G., Alberts M.J., Bhatt D.L., Brass L., Furlan A., Grubb R.L., Higashida R.T., Jauch E.C., Kidwell C., et al. Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–1711. doi: 10.1161/STROKEAHA.107.181486. PubMed DOI
Jauch E.C., Saver J.L., Adams H.P., Bruno A., Connors J.J., Demaerschalk B.M., Khatri P., McMullan P.W., Qureshi A.I., Rosenfield K., et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947. doi: 10.1161/STR.0b013e318284056a. PubMed DOI
Šaňák D., Neumann J., Tomek A., Školoudík D., Škoda O., Mikulík R., Herzig R., Václavík D., Bar M., Roček M., et al. Doporučení pro rekanalizační léčbu akutního mozkového infarktu—Verze 2016. Cesk. Slov. Neurol. N. 2016;79/112:231–234. doi: 10.14735/amcsnn2016231. DOI
Wahlgren N., Moreira T., Michel P., Steiner T., Jansen O., Cognard C., Mattle H.P., Van Zwam W., Holmin S., Tatlisumak T., et al. Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int. J. Stroke. 2016;11:134–147. doi: 10.1177/1747493015609778. PubMed DOI
Campbell B.C., Christensen S., Levi C.R., Desmond P.M., Donnan G.A., Davis S.M., Parsons M.W. Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke. 2011;42:3435–3440. doi: 10.1161/STROKEAHA.111.618355. PubMed DOI
Neumann J., Tomek A., Školoudík D., Škoda O., Mikulík R., Herzig R., Václavík D., Bar M., Šaňák D. Doporučený postup pro intravenózní trombolýzu v léčbě akutního mozkového infarktu—Verze 2014. Cesk. Slov. Neurol. N. 2014;77/110:381–385.
Šaňák D., Nosál V., Horák D., Bártková A., Zeleňák K., Herzig R., Bučil J., Školoudík D., Buřval S., Cisariková V., et al. Impact of diffusion-weighted MRI-measured initial cerebral infarction volume on clinical outcome in acute stroke patients with middle cerebral artery occlusion treated by thrombolysis. Neuroradiology. 2006;48:632–639. doi: 10.1007/s00234-006-0105-0. PubMed DOI
Van Swieten J.C., Koudstaal P.J., Visser M.C., Schouten H.J., Van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–607. doi: 10.1161/01.STR.19.5.604. PubMed DOI
Goldstein L.B., Samsa G.P. Reliability of the National Institute of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke. 1997;28:307–310. doi: 10.1161/01.STR.28.2.307. PubMed DOI
Marek M., Horyniecki M., Fraczek M., Kluczewska E. Leukoaraiosis—New concepts and modern imaging. Pol. J. Radiol. 2018;83:e76–e81. doi: 10.5114/pjr.2018.74344. PubMed DOI PMC
Yoo A.J., Simonsen C.Z., Prabhakaran S., Chaudhry Z.A., Issa M.A., Fugate J.E., Linfante I., Liebeskind D.S., Khatri P., Jovin T.G., et al. Refining angiographic biomarkers of revascularization: Improving outcome prediction after intra-arterial therapy. Stroke. 2013;44:2509–2512. doi: 10.1161/STROKEAHA.113.001990. PubMed DOI PMC
Wahlgren N., Ahmed N., Dávalos A., Ford G.A., Grond M., Hacke W., Hennerici M.G., Kaste M., Kuelkens S., Larrue V., et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): An observational study. Lancet. 2007;369:275–282. doi: 10.1016/S0140-6736(07)60149-4. PubMed DOI
Marini C., Baldassarre M., Russo T., De Santis F., Sacco S., Ciancarelli I., Carolei A. Burden of first-ever ischemic stroke in the oldest old: Evidence from a population-based study. Neurology. 2004;62:77–81. doi: 10.1212/01.WNL.0000101461.61501.65. PubMed DOI
Russo T., Felzani G., Marini C. Stroke in the very old: A systematic review of studies on incidence, outcome, and resource use. J. Aging Res. 2011;2011:108785. doi: 10.4061/2011/108785. PubMed DOI PMC
Kleine J.F., Boeckh-Behrens T., Prothmann S., Zimmer C., Liebig T. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J. Neurointerv. Surg. 2016;8:671–676. doi: 10.1136/neurintsurg-2015-011702. PubMed DOI
Arsava E.M., Rahman R., Rosand J., Lu J., Smith E.E., Rost N.S., Singhal A.B., Lev M.H., Furie K.L., Koroshetz W.J., et al. Severity of leukoaraiosis correlates with clinical outcome after ischemic stroke. Neurology. 2009;72:1403–1410. doi: 10.1212/WNL.0b013e3181a18823. PubMed DOI PMC
Henninger H., Lin E., Baker S.P., Wakhloo A.K., Takhtani D., Moonis M. Leukoaraiosis predicts poor 90-day outcome after acute large cerebral artery occlusion. Cerebrovasc. Dis. 2012;33:525–531. doi: 10.1159/000337335. PubMed DOI
Ribo M., Flores A., Mansilla E., Rubiera M., Tomasello A., Coscojuela P., Pagola J., Rodriguez-Luna D., Muchada M., Alvarez-Sabín J., et al. Age-adjusted infarct volume threshold for good outcome after endovascular treatment. J. Neurointerv. Surg. 2014;6:418–422. doi: 10.1136/neurintsurg-2013-010786. PubMed DOI
Lima A., Haussen D.C., Rebello L.C., Dehkharghani S., Grossberg J., Grigoryan M., Frankel M., Nogueira R.G. Endovascular therapy for large vessel stroke in the elderly: Hope in the new stroke era. Cerebrovasc. Dis. 2016;42:421–427. doi: 10.1159/000446852.. PubMed DOI
Yang P., Zhang Y., Zhang L., Zhang Y., Treurniet K.M.., Chen W., Peng Y., Han H., Wang J., Wang S., et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. J. Clin. Med. 2020;382:1981–1993. doi: 10.1056/NEJMoa2001123. PubMed DOI
Zi W., Qiu Z., Li F., Sang H., Wu D., Luo W., Liu S., Yuan J., Song J., Shi Z., et al. Effect of endovascular treatment alone vs. intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke. The DEVT randomised clinical trial. JAMA. 2021;325:234–243. doi: 10.1001/jama.2020.23523. PubMed DOI PMC
Suzuki K., Matsumaru Y., Takeuchi M., Morimoto M., Kanazawa R., Takayama Y., Kamila Y., Shigeta K., Okubo S., Haykawa M., et al. Effect of mechanical thrombectomy without vs. with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke. The SKIP randomised clinical trial. JAMA. 2021;325:244–253. doi: 10.1001/jama.2020.23522. PubMed DOI PMC
Minnerup J., Wersching H., Teuber A., Wellmann J., Eyding J., Weber R., Reimann G., Weber W., Krause L.U., Kurth T., et al. Outcome after thrombectomy and intravenous thrombolysis in patients with acute ischemic stroke: A prospective observational study. Stroke. 2016;47:1584–1592. doi: 10.1161/STROKEAHA.116.012619. PubMed DOI
Chalos V., LeCouffe N.E., Uyttenboogaart M., Lingsma H.F., Mulder M.J.H.L., Venema E., Treurniet K.M., Eshghi O., Van der Worp H.B., Van der Lugt A., et al. Endovascular treatment with or without prior intravenous alteplase for acute ischemic stroke. J. Am. Heart Assoc. 2019;8:e011592. doi: 10.1161/JAHA.118.011592. PubMed DOI PMC
Ahmed N., Mazya M., Nunes A.P., Moreira T., Ollikainen J.P., Escudero-Martinez I., Bigliardi G., Dorado L., Dávalos A., Egido J.A., et al. Safety and outcomes of thrombectomy in ischemic stroke with vs. without intravenous thrombolysis. Neurology. 2021;97:e765–e776. doi: 10.1212/WNL.0000000000012327. PubMed DOI
Hacke W., Kaste M., Fieschi C., Von Kummer R., Davalos A., Meier D., Larrue V., Bluhmki E., Davis S., Donnan G., et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) Lancet. 1998;352:1245–1251. doi: 10.1016/S0140-6736(98)08020-9. PubMed DOI
Kidwell C.S., Latour L., Saver J.L., Alger J.R., Starkman S., Duckwiler G., Jahan R., Vinuela F., Kang D.W., Warach S. Thrombolytic toxicity: Blood brain barrier disruption in human ischemic stroke. Cerebrovasc. Dis. 2008;25:338–343. doi: 10.1159/000118379. PubMed DOI
Strbian D., Engelter S., Michel P., Meretoja A., Sekoranja L., Ahlhelm F.J., Mustanoja S., Kuzmanovic I., Sairanen T., Forss N., et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN score. Ann. Neurol. 2012;71:634–641. doi: 10.1002/ana.23546. PubMed DOI
Chalos V., De Ridder I.R., Lingsma H.F., Brown S., Van Oostenbrugge R.J., Goyal M., Campbell B.C.V., Muir K.W., Guillemin F., Bracard S., et al. Does sex modify the effect of endovascular treatment for ischemic stroke? Stroke. 2019;50:2413–2419. doi: 10.1161/STROKEAHA.118.023743. PubMed DOI PMC
Sheth S.A., Lee S., Warach S.J., Gralla J., Jahan R., Goayl M., Nogueira R.G., Zaidat O.O., Pereira V.M., Siddiqui A., et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke. 2019;50:2420–2427. doi: 10.1161/STROKEAHA.118.023867. PubMed DOI PMC
Uchida K., Yoshimura S., Sakai N., Yamagami H., Morimoto T. Sex differences in management and outcomes of acute ischemic stroke with large vessel occlusion. Stroke. 2019;50:1915–1918. doi: 10.1161/STROKEAHA.119.025344. PubMed DOI
Madsen T.E., DeCroce-Movson E., Hemendinger M., McTaggart R.A., Yaghi S., Cutting S., Furie K.L., Saad A., Siket M.S., Jayaraman M.V. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J. Neurointerv. Surg. 2019;11:221–225. doi: 10.1136/neurintsurg-2018-014050. PubMed DOI