Abstract TP185: Impact of Age on Revascularization and Early Outcomes Post Mechanical Thrombectomy in Acute Ischemic Strokes with Large Vessel Occlusion; A Single Center Real World Data Analysis


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Abstract

Background: Recently, five randomized control trials have demonstrated superiority of endovascular therapy (ET) to medical management in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO). Some concerns have arisen in subset and meta analyses of the pivotal trials regarding the negative effect of advanced age (>80 years) on outcomes after ET.Methods: A retrospective analysis of patients with proven LVO who underwent ET was conducted from January 2015 to June 2016. Patients were divided in two groups based on age (≤80 and >80 years) and were analyzed for degree of revascularization (TICI score) and functional status at discharge using the modified Rankin Scale (mRS).Results: Fifty-four patients received ET during the study period. Those who had posterior circulation LVO and/or treated after 6 hours from last known normal were excluded, leaving 34 patients for final analysis. Twenty-two (64%) patients were ≤80 and 12 (36%) were >80. Seventy-seven percent of patients ≤ 80 had favorable recanalization (TICI ≥ 2b) while 66 % of patients > 80 had TICI ≥ 2b (p value 0.69). Of patients >80 years, 0 % had a mRS ≤2 at discharge versus 36.3% ≤80 years (p value 0.03). Similarly, 25% of patients > 80 and 54.5% of ≤80 had mRS 3 or 4 (p value 0.15). Only 9% of ≤ 80 had mRS >4, as compared to >80 at 75% (p value <0.01). No statistically significant differences were found in the average time to revascularization, admitting NIHSS or administration of tPA.Conclusion: Age above 80 is a predictor of poor outcome after ET irrespective of successful recanalization. Our results confirm the questions raised in previous subset analyses. The reason octogenarians do poorly remains unclear, but our data suggests factors other than TICI score and time to revascularization. Although ET has shown superiority in AIS with LVO, further consideration and careful selection is recommended in patients above age of 80. More focused randomized control trials are needed to get a definitive answer.

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