Poor Outcomes of Elderly Patients Undergoing Multimodality Intra-arterial Therapy for Acute Ischemic Stroke
The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (≥80 years) to non-elderly patients (<80 years) who underwent multimodality IAT.
From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged ≥80 years were compared to the patients <80 years.
Between 2008 and 2012, 24 patients ≥80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p = <0.001), atrial fibrillation (58.3% vs. 25.2%, p = 0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs 16.3, p = 0.17), THRIVE Score (4.21 vs. 4.39, p = 0.633), recanalization rate (70.1% vs. 85.3%, p = 0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p = 0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p = 0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p = <0.001). After controlling for baseline factors, only female gender (OR 5.3, 95%CI 1.7–16.7; p = 0.04) and higher 3-month mRS (OR 1.6; 95%CI 1.1–2.40; p = 0.008) were independently associated with elderly age.
Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously after careful analysis of the risks and benefits for each patient.
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