Efficacy and Safety of Mechanical Thrombectomy in Elderly and Non-Elderly Patients with Large Vessel Occlusion Stroke: Systematic Review and Meta-Analysis.

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-01-01 Epub Date: 2023-10-09 DOI:10.1159/000533204

Aisha Ali, Fernando D Testai, Gabriela Trifan

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引用次数: 0

Abstract

Introduction: Mechanical thrombectomy (MT) is recommended for large vessel occlusion (LVO) stroke. However, most of the studies that investigated the superiority of MT over best medical management (BMM) alone included preponderantly non-elderly patients. Thus, there is uncertainty in relation to the efficacy of MT in the elderly. We aim to compare the effect of BMM to BMM plus MT among elderly and non-elderly patients with LVO.

Methods: We performed a systematic search of medical databases from inception to April 2023 to identify randomized studies that reported the functional outcome at 90 days by age for patients with LVO treated with MT versus BMM. Patients were divided into elderly (>70 or >80 years, depending on the cutoff used in each study) and non-elderly. Outcomes were defined as excellent (modified Rankin Scale [mRS] ≤1), good (mRS ≤3), poor (mRS ≥5), or death. Effect sizes were calculated by using random effects meta-analyses. Results were represented by odds ratio (OR) and their 95% confidence intervals (95% CIs).

Results: A total of 2,195 patients were included in the analysis (≥70 years, 7 trials, n = 696; ≥80 years, 2 trials, n = 139). Non-elderly patients treated with MT had higher odds of excellent outcome (OR: 3.05; 95% CI: 2.23-4.18) and good outcome (OR: 2.70; 95% CI: 1.94-3.74), and lower odds of poor outcome (OR: 0.54; 95% CI: 0.40-0.72) and death (OR: 0.63; 95% CI: 0.41-0.96). Similarly, elderly patients treated with MT had higher odds of excellent (OR: 2.39; 95% CI: 1.05-5.45) and good outcomes (OR: 2.18; 95% CI: 1.43-3.33) and lower odds of poor outcome (OR: 0.48; 95% CI: 0.33-0.70) and mortality (OR: 0.50; 0.26-0.95). When outcomes were analyzed by age subgroups, MT was associated with higher odds of good outcome in patients ≥70 years (OR: 1.95, 95% CI: 1.26-3.03) and ≥80 years (OR: 4.43, 95% CI: 1.02-19.23).

Conclusion: MT increases the likelihood of achieving a good outcome in elderly and non-elderly patients without increasing the risk of severe disability or death. MT, when otherwise clinically indicated, should be considered over BMM alone in both age groups.

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老年和非老年大血管闭塞性脑卒中患者机械性血栓切除术的疗效和安全性——系统评价和荟萃分析。

引言机械血栓切除术（MT）推荐用于大血管闭塞（LVO）卒中。然而，大多数调查MT优于单独最佳医疗管理（BMM）的研究主要包括非老年患者。因此，MT在老年人中的疗效存在不确定性。我们的目的是比较BMM和BMM+（MT）在老年和非老年LVO患者中的效果。方法从开始到2023年4月，我们对医学数据库进行了系统搜索，以确定随机研究，这些研究报告了MT与BMM治疗的LVO患者在90天时的功能结果。患者被分为老年人（>70或>80岁，取决于每项研究中使用的截止值）和非老年人。结果被定义为优秀（改良兰金量表[mRS]≤1）、良好（mRS≤3）、差（mRS≥5）或死亡。通过使用随机效应荟萃分析计算效应大小。结果用比值比（OR）和95%置信区间（95%CI）表示。结果共有2195名患者被纳入分析（≥70岁，7项试验，n=696；≥80岁，2项试验，n=139）。接受MT治疗的非老年患者有较高的优良结局（OR 3.05；95%CI 2.23-4.18）和良好结局（OR 2.70；95%CI 1.94-3.74）的几率，以及较低的不良结局（OR 0.54；95%CI 0.40-0.72）和死亡（OR 0.63；95%CI 0.41-0.96）的几率，接受MT治疗的老年患者具有较高的优良率（OR 2.39；95%CI 1.05-5.45）和良好结果（OR 2.18；95%CI 1.43-3.33），以及较低的不良结果（OR 0.48；95%CI0.33-0.70）和死亡率（OR 0.50；0.26-0.95），MT与≥70岁（OR 1.95，95%CI 1.26-3.03）和≥80岁（OR 4.43，95%CI 1.02-19.23）患者获得良好结果的几率较高有关。讨论/结论MT增加了老年和非老年患者获得良好结局的可能性，而不会增加严重残疾或死亡的风险。当临床上有其他指示时，在两个年龄组中，MT应被认为超过单独的BMM。

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

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.