返回Google圖書搜尋

DIMINISHED LIKELIHOOD OF FAVORABLE STROKE OUTCOMES FOLLOWING ENDOVASCULAR THERAPY IN OCTOGENARIANS

出版	2017
URL	http://books.google.com.hk/books?id=lNG1zQEACAAJ&hl=&source=gbs_api

註釋Randomized controlled trials data suggest a benefit of endovascular therapy (EVT) in older patients with anterior circulation large vessel occlusion (acLVO), real world evidence is lacking. We aimed to explore the likelihood of favorable stroke outcome in octogenarians undergoing EVT for acLVO. We prospectively studied ischemic stroke patients u2265 80 years who were considered for EVT due to acLVO at our tertiary stroke center (01/2016-06/2018). We compared clinical characteristics and efficacy outcomes including 90-days functional independence (mRS 0-2) and 90-days survival among patients who underwent EVT and those who did not.185 patients u2265 80 years were screened for EVT during the 30-months period: median age was 84 years (IQR, 82-88); 30% were men; median NIHSS was 18 (IQR, 14-21) points. Of these patients, 97 (52.4%) were treated for proximal acLVO. The main reasons to withhold EVT were large infarct size (54.6%), recanalization (30.7%), unknown time window (5.7%), lack of perfusion mismatch or collaterals (4.5%) and early clinical improvement (2.3%). There were no differences according to vascular risk factors, baseline imaging and clinical variables. There was a non-significant trend toward survival (50.6% versus 37.3%, p=0.09) but not functional independence (9.9% versus 5.3%, p=0.39) at 90 days in patients who underwent EVT compared with the non-EVT group. In the multivariable model, favorable outcomes were not predicted by pre-stroke disability, stroke severity, infarct size or treatment with intravenous tPA. While age alone should not exclude patients from endovascular therapy, diminished likelihood of favorable outcomes may challenge postacute stroke care in octogenarians.