title: Patient selection for stroke endovascular therapy--DWI-ASPECTS thresholds should vary among age groups: insights from the RECOST study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the benefits of endovascular intervention in large-vessel occlusion strokes, depending on age class.
  
  
  METHODS
  A clinical management protocol including intravenous treatment and mechanical thrombectomy was instigated in our center in 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] study). All patients with acute ischemic stroke with an anterior circulation major-vessel occlusion who presented within 6 hours were evaluated with an initial MR imaging examination and were analyzed according to age subgroups (younger than 50 years, 50-59 years, 60-69 years, 70-79 years; 80 years or older). The mRS score at 3 months was the study end point.
  
  
  RESULTS
  One hundred sixty-five patients were included in the analysis. The mean age was 67.4 years (range, 29-90 years). The mean baseline NIHSS score was 17.24 (range, 3-27). The mean DWI-derived ASPECTS was 6.4. Recanalization of TICI 2b/3 was achieved in 80%. At 3 months, 41.72% of patients had a good outcome, with a gradation of prognosis depending on the age subgroup and a clear cutoff at 70 years. Only 19% of patients older than 80 years had a good outcome at 3 months (mean ASPECTS = 7.4) with 28% for 70-79 years (mean ASPECTS = 6.8), but 58% for 60-69 years (mean ASPECTS = 6), 52% for 50-59 years (mean ASPECTS = 5.91), and 72% for younger than 50 years (mean ASPECTS = 6.31). In contrast, the mortality rate was 35% for 80 years and older, and 26% for 70-79 versus 5%-9% for younger than 70 years.
  
  
  CONCLUSIONS
  The elderly may benefit from thrombectomy when their ischemic core volume is low in comparison with younger patients who still benefit from acute recanalization despite larger infarcts. Stroke volume thresholds should, therefore, be related and adjusted to the patient's age group.
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: F
authors.initials: F
authors.lastname: Danière
authors.affiliation: Imaging Department (K.L.), Imperial College Healthcare National Health Service Trust, Charing Cross Hospital, London, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Lobotesis
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: P
authors.initials: P
authors.lastname: Machi
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: O
authors.initials: O
authors.lastname: Eker
authors.affiliation: Neurology (I.M., X.A., C.A.).
authors.forename: I
authors.initials: I
authors.lastname: Mourand
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: C
authors.initials: C
authors.lastname: Riquelme
authors.affiliation: Neurology (I.M., X.A., C.A.).
authors.forename: X
authors.initials: X
authors.lastname: Ayrignac
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: J F
authors.initials: JF
authors.lastname: Vendrell
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: G
authors.initials: G
authors.lastname: Gascou
authors.affiliation: Anesthesiology (J.F.), CHU Montpellier, Montpellier, France.
authors.forename: J
authors.initials: J
authors.lastname: Fendeleur
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: C
authors.initials: C
authors.lastname: Dargazanli
authors.affiliation: Department of Medical Statistics (R.S.), CHU Montpellier, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France.
authors.forename: R
authors.initials: R
authors.lastname: Schaub
authors.affiliation: Department of Neuroradiology (H.B.), CHU Marseille, Hôpital La Timone, Marseille, France.
authors.forename: H
authors.initials: H
authors.lastname: Brunel
authors.affiliation: Neurology (I.M., X.A., C.A.).
authors.forename: C
authors.initials: C
authors.lastname: Arquizan
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
authors.forename: A
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.) v-costalat@chu-montpellier.fr.
authors.forename: V
authors.initials: V
authors.lastname: Costalat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult