Abstract T P23: Endovascular Treatment of Stroke in Elderly Patients: Comparison With Conventional Thrombolysis and Best Medical Treatment
Background and Purpose: Elderly patients have often been excluded from randomized stroke trials. The benefit of endovascular treatment of stroke in these patients remains uncertain. We sought to evaluate the outcomes of elderly patients treated endovascularly compared to those treated with conventional thrombolysis or best medical therapy.
Methods: We retrospectively reviewed all stroke patients admitted to our center between 2008-2011. We included all patients age 75 or older with large vessel occlusion presenting within 8 hours of stroke onset. We evaluated outcomes at discharge including modified rankin score (mRS) and mortality as well as symptomatic intracerebral hemorrhage (sICH) within 24 hours for patients receiving endovascular treatment (EVT) with or without conventional thrombolysis , intravenous thrombolysis (IVT) or best medical treatment (BMT). Good outcome was defined as mRS of 3 or less at discharge.
Results: A total of 91 patients met the inclusion criteria. 41 patients underwent EVT, 19 received IVtpa, and 31 BMT. Baseline NIHSS was not significantly different between the groups (17 SD 7, 16 SD 5, 14 SD 8 respectively). There was no difference in good outcomes between patients undergoing EVT compared to BMT (unadjusted OR 1.46, 95% CI 0.44-4.9), IVT compared to BMT (OR 2.4, 95% CI 0.62-9.36), or EVT compared to IVT (OR 0.61, 95% CI 0.18-2.06). There was no difference in mortality for the EVT, IVT, and BMT groups (22%, 26%, and 16% respectively, chi square p=0.79 for intergroup differences). Similarly there was no difference in rates of sICH 12%, 11%, and 3% p=0.41.
Conclusion: Despite similar mortality and cerebral hemorrhage rates, we found no difference in good outcome for elderly patients treated with endovascular therapy or intravenous thrombolysis compared to best medical treatment within 8 hours of stroke onset. Larger studies are needed to clarify the role of intervention in elderly stroke patients.
Author Disclosures: M.H. El-Ghanem: None. C.J. Prestigiacomo: None. C.D. Gandhi: None. E. Duffis: None.
- © 2014 by American Heart Association, Inc.