Abstract W MP5: Successful Revascularization in Octogenarians with Acute Ischemic Stroke Predicts Good 90-day Outcomes
Background: Octogenarians represent one of the fastest growing populations in the US. Yet, limited data exists about endovascular therapy in this population because of the tendency not to treat this population too aggressively. We present the largest single group experience of multimodal endovascular treatment of ischemic stroke in patients ≥80 years.
Methods: Retrospective review of our neurointerventional database was conducted to include patients age ≥80 years treated with endovascular therapy from 2008 to 2014. Seventy patients were identified (42 females, average age 84 years, range 80-93). Recanalization was assessed by the TICI grade (0-3). Outcomes were assessed by the 90-day mRS.
Results: Fifteen (21%) patients received IA TPA±IV TPA. Thirty-one(44%) received IA TPA/older thrombectomy devices(Merci or Penumbra)±IV TPA. Twenty-four were treated with stent retrievers±IV/IA TPA. Prior to introduction of stent retrievers, 29/46(63%) achieved successful revascularization (TICI 2b or 3) versus 22/24(92%) after introduction of stent retrievers (p=.01). An improvement in the NIHSS was seen in 46% of patients at discharge prior to stent retrievers and 67% with stent retrievers(p=0.07). Before stent retrievers 25% had good outcomes (mRS≤2) and 38% had good outcomes with stent retrievers (p=0.2). All patients with good outcomes were successfully recanalized with TICI score of 2B/3. If we could not recanalize patients, none of the patients had good outcomes (patients TICI 0-2A all had poor outcomes or died). Twenty-three (33%) patients died. However, if the patient lived, 27 (61%) patients were independent or needed only minimal assistance (mRS≤3). There were 6 hemorrhagic complications.
Conclusion: Multimodal endovascular therapy in the treatment of acute ischemic stroke is relatively effective and safe in the elderly, especially with the advent of stent retrievers. If the occluded vessel can be successfully recanalized and the patient survives, they can continue with a good quality of life. Unsuccessful revascularization leads to poor outcomes. This study and other future prospective studies are essential in helping guide families in making difficult treatment decisions about elderly family members.
Author Disclosures: P. Moftakhar: None. A. Bakhtmand: None. U. Tolley: None. H. Sachdev: None. R. Guisado: None. A. Padidar: None. R. Malek: None.
- © 2015 by American Heart Association, Inc.