title: Endovascular Therapy for Large Vessel Stroke in the Elderly: Hope in the New Stroke Era.
abstract: Acute ischemic stroke (AIS) in the elderly encompasses approximately one-third of all AIS cases. Outcome data have been for the most part discouraging in this population. We aim to evaluate the outcomes in a large contemporary series of elderly patients treated with thrombectomy.
  
  
  
  Retrospective analysis of a single-center endovascular database for consecutive elderly (≥80 years) patients treated for anterior circulation large vessel occlusion AIS between September 2010 and April 2015. Univariate- and multivariate analyses were performed to identify the predictors of good clinical outcome (90-day modified Ranking Scale [mRS] ≤2). Receiver operating characteristic curves were used to calculate the optimal final infarct volume (FIV) threshold to predict good outcomes.
  
  
  
  A total of 111 patients met our inclusion criteria (mean age 84.8 ± 4.2 years; National Institutes of Health Stroke Scale [NIHSS] score 19.1 ± 5.6; time from last-known normal to puncture, 349.6 ± 246.6 min; 33% male; 68% Alberta Stroke Program Early CT Score [ASPECTS] ≥8). The rates of successful reperfusion (modified treatment in cerebral ischemia ≥2b), symptomatic intracranial hemorrhage and 90-day mortality were 80%, 7% and 41%, respectively. The overall rate of good outcome was 29% (n = 32/111) but was 52% (n = 13/25) in patients with baseline mRS score of 0-2 who were selected based on CT perfusion and treated with stent retrievers. On multivariate analysis, only ASPECTS (OR 2.17; 95% CI 1.28-3.67.7; p = 0.004) and baseline NIHSS score (OR 0.87; 95% CI 0.77-0.97; p = 0.013) were independently associated with good outcome. A FIV ≤16 ml demonstrated the greatest accuracy for identifying good outcomes (sensitivity 75.0%, specificity 82.6%).
  
  
  
  Our results are encouraging demonstrating nearly one-third of elderly patients achieving full independence at 90 days. Contemporary treatment paradigms employing optimized patient selection and modern thrombectomy technology may result in even better outcomes.
authors.affiliation: Emory University School of Medicine/Marcus Stroke and Neuroscience Center - Grady Memorial Hospital, Atlanta, Ga., USA.
authors.forename: Andrey
authors.initials: A
authors.lastname: Lima
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.forename: Leticia C
authors.initials: LC
authors.lastname: Rebello
authors.forename: Seena
authors.initials: S
authors.lastname: Dehkharghani
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grossberg
authors.forename: Mikayel
authors.initials: M
authors.lastname: Grigoryan
authors.forename: Michael
authors.initials: M
authors.lastname: Frankel
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D020520:Brain Infarction / Q000175:diagnosis / Q000628:therapy*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004185:Disability Evaluation; D057510:Endovascular Procedures; D005260:Female; D005845:Georgia; D006299:Health Services for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D055420:Perfusion Imaging / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome