The average age was 84.4 years (range 81-94). Fig. 1.
31.7% were men and 68.3% were women.
All patients had a baseline mRs ≤ 2.
The median of the ASPECTS was 9,
with an average of NIHSS of 19. Fig. 2.
Successful recanalization (mTICI 2b-3) was achieved in 81.7% of cases. Fig. 3 .
35.6% of the patients achieved functional independence (mRS ≤ 2) at 3 months,
and 17% a mild dependence (mRS 3).
The 3-month mortality rate was 18,6%,
and the rate of clinically significant hemorrhagic transformations was 10.3%. Fig. 4. Fig. 5.
Fig. 4: Scores on the modified Rankin Scale at 90 days. Distribution of scores at 90 days in our study.
The statistical analysis didn’t show significant differences in most of the studied variables.
However,
when we compared the group that obtained mRS90 2 or lower with the group that obtained mRS90 >2 significant differences were observed in three variables: the duration of the procedure,
the NIHSS at 24 hours and the successful recanalization (mTICI 2b-3). Table 1. Table 2.
In the group that obtained functional positive outcome at 90 days,
the duration of the procedure was significantly shorter (59 min vs 84 min; p 0.04 (3.9-47.1)),
the NIHSS at 24 hours was significantly lower (NIHSS 4.8 vs 14 p <0.001 (6.2-12)),
and the successful recanalization rate was higher (x2 7,42 (p 0,006)).
DISCUSSION:
We obtained poorer outcomes tan the HERMES and REVASCAT studies with lower recanalization rate and favorable functional outcome rate,
and higher mortality.
Fig. 6. Fig. 7.
HERMES (reference 1) is a meta-analysis of five trials that confirmed the benefit of thrombectomy compared to medical treatment in in patients with anterior circulation stroke.
REVASCAT (reference 2) is a multicenter trial where the reduction of post-stroke disability and increase of functional independence is confirmed in patients with anterior circulation stroke treated with thrombectomy in the first eight hours.
We consider that our poorer results were due to the study population since in both this studies only patients under 80 years old were included.
Fig. 6: Successful recanalization rate, positive functional result and mortality rate comparison.
Fig. 7: Scores on the modified Rankin Scale at 90 days. Distribution of scores at 90 days in our study comparing to HERMES and REVASCAT studies.
On the other side our study obtained higher recanalization rate and favorable functional outcome rate,
and lower mortality than the study "Endovascular treatment in elderly patient. Should we continue treating them?".
Fig. 8. Fig. 9.
This is a retrospective multicentre study conducted in our area (Barcelona,
Spain) where patients with anterior circulation stroke treated by thrombectomy younger and older than 80 years old were compared.
They concluded that those over 80 had a lower percentage of favorable functional outcome and higher mortality and recommended using more restrictive criteria in elderly patients when performing mechanical thrombectomies.
We observed that the criteria used in our center for therapy assessment in elderly patients tend to be more restrictive (baseline mRs ≤ 2,
median ASPECTS 9 and average NIHSS 19).
We believe that this might explain our better results. A possible pathway for future research could be the assessment of the best criteria to be used in elderly patients with anterior circulation acute stroke.
Fig. 8: Successful recanalization rate, positive functional result and mortality rate comparison.
Fig. 9: Scores on the modified Rankin Scale at 90 days. Distribution of scores at 90 days in our study comparing to "STROKE" study (ref. 3).