title: Does Reducing the Duration from Symptom Onset to Recanalization Improve the Results of Intracranial Mechanical Thrombectomy in the Elderly?
abstract: Endovascular recanalization for acute major cerebral artery occlusion is effective within a short time after symptom onset. However, its efficacy in the elderly remains unknown. We assessed the efficacy of our comprehensive stroke center's reduction of this time in 28 consecutive patients for elderly patients (defined as patients aged ≥75 years) with acute major cerebral artery occlusion treated with intravenous injection of tissue plasminogen activator, followed by thrombus retrieval by endovascular therapy. The patients were divided into groups according to whether they were treated before implementation of the time reduction measure (from January 2012 to May 2014) or after (from June 2014 to May 2015). The onset-to-door, onset-to-needle, onset-to-recanalization (O2R), door-to-image (D2I), door-to-needle (D2N), door-to-puncture (D2P), door-to-recanalization (D2R), and puncture-to-recanalization time intervals were compared between the two groups. There were 14 patients (including 8 elderly patients ≥80 years) before and 14 patients (including 10 elderly patients ≥80 years) after the time reduction measure. The mean duration of each of the following time intervals was significantly reduced after the time reduction measure (P < 0.05). To reduce the O2R time, the D2P time is the first time interval that can be reduced. At our center, conferences were regularly held to raise awareness among staff and make specific changes in the workflow, and overall time reduction was achieved. Similar results were obtained in elderly patients.
authors.affiliation: Department of Neurosurgery, Kyorin University Faculty of Medicine.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Komatsubara
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Dembo
authors.forename: Eishi
authors.initials: E
authors.lastname: Sato
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sasamori
authors.forename: Masataka
authors.initials: M
authors.lastname: Torii
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hirano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D016896:Treatment Outcome