Impact of Baseline Ischemia on Outcome in Older Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke
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Background and Purpose The outcome for older stroke patients who undergo endovascular revascularization remains unsatisfactory. We aimed to determine the effect of the extent of baseline ischemia on outcome according to age, testing the hypothesis that the restorative capacity for recovery is only marginal in older patients. Methods Two hundred and thirteen patients who underwent endovascular revascularization due to occlusion in the M1 segment of the middle cerebral artery (with or without internal carotid artery occlusions) were selected for analysis. Patients were categorized into three age groups: group A (<66 years), group B (66–75 years), and group C (>75 years). Using pretreatment diffusion-weighted imaging (DWI), the Alberta Stroke Program Early CT Score (ASPECTS) and lesion volume were independently measured and analyzed in relation to a favorable outcome. Results A favorable outcome was achieved in 111 of 213 patients overall: in 60 of the 94 (63.8%) patients in group A, in 36 of the 70 (51.4%) patients in group B, and in 15 of the 49 (30.6%) patients in group C (p=0.001). In older stroke patients (group C), a DWI ASPECTS ≥9 and lesion volume ≤5 mL were found to predict a favorable outcome, which was more restrictive than the cutoffs for their younger counterparts (groups A and B; DWI ASPECTS ≥8 and lesion volume ≤20 mL). Conclusions The age-adjusted pretreatment DWI lesion volume and ASPECTS may represent useful surrogate markers for functional outcome according to age. The use of more-restrictive inclusion criteria for older stroke patients could be warranted, although larger studies are necessary to confirm these findings.
Abstract
Background and Purpose The outcome for older stroke patients who undergo endovascular revascularization remains unsatisfactory. We aimed to determine the effect of the extent of baseline ischemia on outcome according to age, testing the hypothesis that the restorative capacity for recovery is only marginal in older patients. Methods Two hundred and thirteen patients who underwent endovascular revascularization due to occlusion in the M1 segment of the middle cerebral artery (with or without internal carotid artery occlusions) were selected for analysis. Patients were categorized into three age groups: group A (<66 years), group B (66–75 years), and group C (>75 years). Using pretreatment diffusion-weighted imaging (DWI), the Alberta Stroke Program Early CT Score (ASPECTS) and lesion volume were independently measured and analyzed in relation to a favorable outcome. Results A favorable outcome was achieved in 111 of 213 patients overall: in 60 of the 94 (63.8%) patients in group A, in 36 of the 70 (51.4%) patients in group B, and in 15 of the 49 (30.6%) patients in group C (p=0.001). In older stroke patients (group C), a DWI ASPECTS ≥9 and lesion volume ≤5 mL were found to predict a favorable outcome, which was more restrictive than the cutoffs for their younger counterparts (groups A and B; DWI ASPECTS ≥8 and lesion volume ≤20 mL). Conclusions The age-adjusted pretreatment DWI lesion volume and ASPECTS may represent useful surrogate markers for functional outcome according to age. The use of more-restrictive inclusion criteria for older stroke patients could be warranted, although larger studies are necessary to confirm these findings.
참고문헌 (31)
- Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
- Campbell BC, "Endovascular therapy for ischemic stroke with perfusionimaging selection", N Engl J Med, 372, pp.1009~1018 (2015)
- Goyal M, "Randomized assessment of rapid endovascular treatment of ischemic stroke", N Engl J Med, 372, pp.1019~1030 (2015)
- Saver JL, "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke", N Engl J Med, 372, pp.2285~2295 (2015)
- Jovin TG, "Thrombectomy within 8 hours after symptom onset in ischemic stroke", N Engl J Med, 372, pp.2296~2306 (2015)
- Keun-Sik Hong, "Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke", 대한뇌졸중학회지, 15(1), pp.2~20 (2013), 대한뇌졸중학회[DOI]
- Kim D, "Intra-arterial thrombolysis for acute stroke in patients 80 and older: a comparison of results in patients younger than 80 years", AJNR Am J Neuroradiol, 28, pp.159~163 (2007)
- Qureshi AI, "Intraarterial recanalization techniques for patients 80 years or older with acute ischemic stroke: pooled analysis from 4 prospective studies", AJNR Am J Neuroradiol, 30, pp.1184~1189 (2009)
- Loh Y, "Higher rates of mortality but not morbidity follow intracranial mechanical thrombectomy in the elderly", AJNR Am J Neuroradiol, 31, pp.1181~1185 (2010)
- Mazighi M, "Impact of a combined intravenous", intra-arterial approach in octogenarians, 2011, pp.31, 559~565
- Mono ML, "Intra-arterial thrombolysis for acute ischemic stroke in octogenarians", Cerebrovasc Dis, 33, pp.116~122 (2012)
- Chandra RV, "Elderly patients are at higher risk for poor outcomes after intra-arterial therapy", Stroke, 43, pp.2356~2361 (2012)
- Johnson JN, "Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke", Clin Neurol Neurosurg, 123, pp.136~141 (2014)
- Parrilla G, "Recanalization and mortality rates of thrombectomy with stent-retrievers in octogenarian patients with acute ischemic stroke", Cardiovasc Intervent Radiol, 38, pp.288~294 (2015)
- Singer OC, "Age dependency of successful recanalization in anterior circulation stroke: the ENDOSTROKE study", Cerebrovasc Dis, 36, pp.437~445 (2013)
- Petcu EB, "Cellular and molecular events underlying the dysregulated response of the aged brain to stroke: a mini-review", Gerontology, 54, pp.6~17 (2008)
- Inoue M, "Impact of diffusion-weighted imaging Alberta stroke program early computed tomography score on the success of endovascular reperfusion therapy", Stroke, 45, pp.1992~1998 (2014)
- Yoo AJ, "Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy", Stroke, 45, pp.746~751 (2014)
- Ribo M, "Age-adjusted infarct volume threshold for good outcome after endovascular treatment", J Neurointerv Surg, 6, pp.418~422 (2014)
- Hwang YH, "Outcome of forced-suction thrombectomy in acute intracranial internal carotid occlusion", J Neurointerv Surg, 5(Suppl 1), pp.i81~i84 (2013)
- Kang DH, "Direct thrombus retrieval using the reperfusion catheter of the penumbra system:forced-suction thrombectomy in acute ischemic stroke", AJNR Am J Neuroradiol, 32, pp.283~287 (2011)
- Kang DH, "Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation", Stroke, 44, pp.3577~3579 (2013)
- Higashida RT, "Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke", Stroke, 34, pp.e109~e137 (2003)
- Hacke W, "Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators", Lancet, 352, pp.1245~1251 (1998)
- Saver JL, "Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallelgroup, non-inferiority trial", Lancet, 380, pp.1241~1249 (2012)
- Barber PA, "Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score", Lancet, 355, pp.1670~1674 (2000)
- van Swieten JC, "Interobserver agreement for the assessment of handicap in stroke patients", Stroke, 19, pp.604~607 (1988)
- Sharma JC, "Strokes in the elderly-higher acute and 3-month mortality-an explanation", Cerebrovasc Dis, 9, pp.2~9 (1999)
- Chandra RV, "Clinical outcome after intra-arterial stroke therapy in the very elderly: why is it so heterogeneous?", Front Neurol, 5, pp.60~ (2014)
- Arsava EM, "The detrimental effect of aging on leptomeningeal collaterals in ischemic stroke", J Stroke Cerebrovasc Dis, 23, pp.421~426 (2014)
- McTaggart RA, "Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction", Stroke, 46, pp.407~412 (2015)