title: Age dependency of successful recanalization in anterior circulation stroke: the ENDOSTROKE study.
abstract: BACKGROUND
  Clinical outcome after endovascular stroke therapy (EVT) for proximal anterior circulation stroke is often disappointing despite high recanalization rates. The ENDOSTROKE study aims to determine predictors of clinical outcome in patients undergoing EVT. Here we focus on the impact of age and recanalization on proximal middle cerebral artery (M1-MCA) or carotid T occlusion.
  
  
  METHODS
  ENDOSTROKE is an investigator-initiated, industrially independent multicenter registry launched in January, 2011, for consecutive patients undergoing EVT for large-vessel stroke. This analysis focuses on patients treated in 11 academic and nonacademic stroke centers with angiographically proven M1-MCA (n = 259) or carotid T occlusion (n = 103). Recanalization was defined as Thrombolysis in Myocardial Infarction (TIMI) score 2 or 3, and in patients with available Thrombolysis in Cerebral Ischemia (TICI) data (n = 309) as TICI scores 2b-3. Good outcome was defined as modified Rankin Scale (mRS) score of 0-2 assessed after 3 months or later.
  
  
  RESULTS
  The median age was 68 years (25th and 75th percentiles: 56, 76 years), and the median National Institutes of Health Stroke Scale (NIHSS) score at admission was 16 (13, 19); 41% of the patients had a favorable (mRS scores 0-2), and 59% had an unfavorable (mRS scores 3-6) outcome; 83% reached TIMI 2-3 flow. Independent predictors of good outcome were younger age, lower initial NIHSS scores, TIMI 2/3 recanalization and lower serum glucose levels. Outcome was highly dependent on patients' age: 60% of the patients within the lowest age quartile (range: 18-56 years) experienced good clinical outcome, decreasing stepwise over 47% (57-68 years) and 37% (69-76 years) to 17% in the highest age quartile (77-94 years). The proportion of patients with poor clinical outcome despite TIMI 2/3 recanalization ('futile recanalization') increased dramatically from only 29% in the lowest age quartile over 34% and 40% (2nd and 3rd age quartiles) up to 53% in the highest age quartile. Results were similar in patients with available TICI scores, with 'futile recanalization' rates increasing from 24% to 46% (lowest to highest age quartile).
  
  
  CONCLUSIONS
  This study emphasizes the dramatic impact of patients' age on outcome in EVT for M1-MCA or carotid T occlusion, even in the presence of recanalization. Reasons for this age-related decrease in clinically successful recanalization rates urgently need clarification and may comprise patient-related factors (age-related increase in cardioembolic strokes, collateral status, comorbidities) as well as periprocedural issues (tortuous vessel anatomy in the elderly, age-dependent negative impact of general anesthesia in EVT).
authors.affiliation: Department of Neurology, Goethe University, Frankfurt, Germany.
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Haring
authors.forename: Johannes
authors.initials: J
authors.lastname: Trenkler
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
authors.forename: Georg
authors.initials: G
authors.lastname: Bohner
authors.forename: Arno
authors.initials: A
authors.lastname: Reich
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Bussmeyer
authors.forename: Anastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.forename: Carina
authors.initials: C
authors.lastname: Hohmann
authors.forename: Kurt
authors.initials: K
authors.lastname: Niederkorn
authors.forename: Hannes
authors.initials: H
authors.lastname: Deutschmann
authors.forename: Anett
authors.initials: A
authors.lastname: Stoll
authors.forename: Albrecht
authors.initials: A
authors.lastname: Bormann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jander
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.forename: Johannes
authors.initials: J
authors.lastname: Brenck
authors.forename: Marc U
authors.initials: MU
authors.lastname: Schlamann
authors.forename: Gabor C
authors.initials: GC
authors.lastname: Petzold
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures