title: Poor outcomes of elderly patients undergoing multimodality intra-arterial therapy for acute ischemic stroke.
abstract: OBJECTIVE
  The incidence of acute ischemic stroke is highest in the elderly. Information regarding outcomes of elderly patients undergoing different modalities of intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is scarce and conflicting. This study compares the safety, technical efficacy and outcomes of elderly patients (≥80 years) to non-elderly patients (<80 years) who underwent multimodality IAT.
  
  
  METHODS
  From a registry of consecutive patients treated with IAT for AIS at our institution over a 3.5-year period, patients with anterior circulation occlusions aged ≥80 years were compared to the patients <80 years.
  
  
  RESULTS
  Between 2008 and 2012, 24 patients ≥80 years (elderly) and 95 patients <80 years (non-elderly) received IAT for anterior circulation occlusions. In the elderly, there were more females (66.7% vs. 28.4%, p=<0.001) and atrial fibrillation (58.3% vs. 25.2%, p=0.003). Between the 2 groups, there was no difference in NIHSS score (17.2 vs. 16.3, p=0.17), THRIVE score (4.21 vs. 4.39, p=0.633), recanalization rate (70.1% vs. 85.3%, p=0.13), or severe reperfusion hemorrhages (8.3% vs. 4.2%, p=0.425). There was no significant difference in 3-month mortality (33.3% vs. 16.8%, p=0.28); however, fewer elderly patients reached good 3-month outcome (0% vs. 40.0%, p=<0.001). After controlling for baseline factors, only female gender (OR 5.3, 95% CI 1.7-16.7; p=0.04) and higher 3-month mRS (OR 1.6; 95% CI 1.1-2.40; p=0.008) were independently associated with elderly age.
  
  
  CONCLUSIONS
  Despite similar safety profiles and recanalization rates, elderly patients had poor functional outcomes after IAT. Intra-arterial therapy in the elderly should be pursued very cautiously only after careful analysis of the risks and benefits for each patient.
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA.
authors.forename: Jeremiah N
authors.initials: JN
authors.lastname: Johnson
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Elhammady
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Pao
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA; Department of Neurology, University of Miami, Miller School of Medicine, Miami, USA.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.affiliation: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, USA. Electronic address: sultan@partners.org.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Aziz-Sultan
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015424:Reperfusion; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Aged 80 and over; Endovascular procedures; Intra-arterial therapy; Mechanical thrombolysis; Stroke