Abstract TP6: Octogenerians Have High Rates Of Favorable Outcomes After Endovascular Therapy For Acute Stroke Due To M1 Occlusion If Final Infarct Volumes Are Small
Background and Purpose: Octogenerians have consistently been shown to have poor outcomes after endovascular therapy for acute stroke. On the other hand, final infarct volumes are predictive of outcomes. We sought to explore the relationship between final infarct volumes and outcomes in octogenerians with acute stroke due to M1 MCA occlusion treated with endovascular therapy at our institution.
Methods: Retrospective analysis of an acute stroke endovascular database was performed. Inclusion criteria were acute M1 MCA occlusion and post procedural MRI allowing for final infarct volume analysis through an automated software application.
Results: A total of 219 patients were identified of which 51 (23%) were 80 years or older. Median age in non-octogenerians was 65.5 versus 83 in octogenerians. Females were 51.8% versus 67%, respectively. Median admission NIHSS was 16 versus 17 (p=ns). Median final infarct volume was 43.6 cc vs. 43.3 cc (p=ns). Median time to treatment was 5.6 hours versus 5.5 hours. Successful recanalization rate (TIMI 2/3 flow) was achieved in 139/168 (83%) versus 45/51 (88%) (p=ns). Multivariate analysis, controlling for admission NIHSS score, recanalization and intubation and time from symptom onset to procedure, identified age (OR 0.9, p < 0.0001, 95% CI 0.86-0.93) and final infarct volume (OR 0.98, p < 0.0001, 95% CI 0.97-0.99) as predictors of favorable outcome (mRS 0-2 at 3 months). The rate of favorable outcomes was 89/168 (53%) versus 10/51 (19.6%) (p < 0.0001). Mean final infarct volume in non-octogenerians with good outcome was 40 cc versus 19 cc in octogenerians (p=0.014). In patients with less than 20 cc of final infarct volume, 84% (37 out of 44) of non-octogenerians had a favorable outcome versus 46% (6 out of 7) of octogenerians (p=0.01).
Conclusions: Despite similar recanalization rates and final infarct volumes, outcomes after endovascular therapy for MCA occlusions in octogenerians are worse than in non-octogenerians. However, outcomes are strongly related to infarct volumes and consequently nearly half of octogenerians with final infarct volume of <=20 cc had favorable outcomes. A small final infarct volume is best predicted by successful recanalization and high pre-procedural ASPECT scores (9 or 10).
- © 2012 by American Heart Association, Inc.