Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Jasmine Jost, Lukas Enz, Martina B Goeldlin, Philipp Baumgartner, Davide Strambo, Nabila Wali, Nicolas Martinez-Majander, Georg Kägi, Laura Vandelli, Christoph Riegler, Danna Krupka, Matteo Paolucci, Mauro Magoni, Giovanni Bianco, Hamza Jubran, Dejana R Jovanovic, Tomas Klail, Laura P Westphal, Alexander Salerno, Leon A Rinkel, Laura Mannismäki, Tolga Dittrich, Livio Picchetto, Regina von Rennenberg, Miguel Serôdio, Stefano Forlivesi, Dikran Mardighian, Carlo W Cereda, Ronen R Leker, Visnja Padjen, Mira Katan, Marios-Nikos Psychogios, Urs Fischer, Tomas Dobrocky, Mirjam R Heldner, Patrik Michel, Paul J Nederkoorn, Sami Curtze, Gian Marco De Marchis, Guido Bigliardi, Christian H Nolte, João Pedro Marto, Andrea Zini, Alessandro Pezzini, Susanne Wegener, Marcel Arnold, Stefan T Engelter, Henrik Gensicke
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引用次数: 0

Abstract

Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older.

Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3-5 if pre-stroke mRS 0-2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3-5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0-2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria).

Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3-5 (38.0% vs 8.7%). The odds of poor functional outcome (ORadjusted 2.35 (95%-CI 1.87-2.97); 61.6% vs 38.7%), death (ORadjusted 3.04 (95%-CI 2.60-3.55); 53.9% vs 21.3%) and unsuccessful recanalization (ORadjusted 1.34 (95%-CI 1.14-1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (ORadjusted 0.92 (95%-CI 0.66-1.28); 5.1% vs 5.0%).

Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.

小于90年的缺血性卒中患者血管内治疗的安全性:EVA-TRISP合作的队列研究
导读:关于血管内治疗(EVT)在老年人中的安全性的数据很少。使用来自大型前瞻性EVT登记的数据,我们旨在为90岁及以上患者的EVT决策提供更好的证据。患者和方法:在这项来自EVA-TRISP合作的多中心观察性研究中,将年龄大于或等于90岁的患者与年龄大于或等于90岁的患者进行了比较。结果:在13306名符合条件的患者中,892名年龄大于或等于90岁(6.7%)。高龄患者入院时美国国立卫生研究院卒中量表(NIHSS)中位数较高(16比14),卒中前mRS更可能为3-5(38.0%比8.7%)。功能不良预后的几率(or调整后为2.35 (95% ci 1.87-2.97);61.6% vs 38.7%)、死亡(or校正3.04 (95% ci 2.60-3.55);53.9% vs 21.3%)和再通失败(ORadjusted 1.34 (95% ci 1.14-1.57);32.4% vs 27.2%)在年龄大于或等于90岁的患者中更高。siich的几率没有差异(or校正0.92 (95%-CI 0.66-1.28);5.1% vs 5.0%)。讨论和结论:evt治疗的卒中患者与年轻患者相比,小于90年的患者具有较差的功能结果,死亡率和不成功的再通的几率更高。然而,EVT后sICH发生的概率并没有增加。在高龄患者中支持或反对EVT的决定不应仅仅基于年龄。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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