Reader Response: Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly

Introduction: An overwhelming benefit from endovascular treatment (EVT) of acute ischemic stroke (AIS) has been shown in recent trials, making it the new evidence-based standard of care for ischemic stroke due to anterior circulation large vessel occlusion. We sought to determine usage, safety and efficacy of EVT in patients ≥80 years of age. Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/2009 - 06/2016. Univariate analysis was carried out to compare AIS patients < 80 vs. those ≥ 80yr. Results: Of the total 7,505 AIS patients, 3,722 presented within 12 hr of last known well and of these 334 (334/3722, 9%) underwent EVT. The majority of AIS patients undergoing EVT were younger than 80yr of age (264/334, 79%). Of the patients who underwent EVT, younger patients were more often male, Caucasian, and had stroke risk factors of atrial fibrillation, CAD, hypertension and smokers. The two groups were similar in NIHSS, initial clinical presentation, modified pre-stroke Rankin scale of ≤ 3, and initiation of tPA as a drip and ship or stroke center front-door administration. Higher rates of pneumonia were observed in younger patients while rates of sICH were similar. Younger patients were more often discharged to home/inpatient rehabilitation facility. On univariate analysis, in-hospital mortality was significantly higher in patients ≥ 80yr [Unadj. OR 2.50 (1.24, 5.03), p=0.01], however the strength of the association attenuated substantially after adjusting for significant covariates [Adj. OR 2.34 (0.99, 5.47), p=0.05] (Table). Conclusion: Elderly stroke patients are largely excluded from clinical trials and data are limited on the effectiveness of EVT in this cohort. Our results showed that rate of sICH and adjusted in-hospital mortality was not statistically different between those < 80yr vs. ≥ 80yr. Further studies are needed to explore the functional outcome of the elderly stroke patients undergoing EVT.

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Retrievable stent thrombectomy in acute ischemic stroke: Is it beneficial in the elderly?

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.388 ◽

2019 ◽

Vol 405 ◽

pp. 91-92

Author(s):

F. Perren ◽

O. Kargiotis ◽

A. Terruzzi ◽

D. Krieger ◽

G. Tsivgoulis ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The Elderly ◽

Retrievable Stent

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Reader response: Thrombolysis for acute ischemic stroke in the unwitnessed or extended therapeutic time window

Neurology ◽

10.1212/wnl.0000000000010871 ◽

2020 ◽

Vol 95 (18) ◽

pp. 844.2-845

Author(s):

Koto Ishida

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Reader Response ◽

Time Window ◽

Therapeutic Time Window

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Abstract 3311: Acute stroke and endovascular outcomes in Elderly Population: A Single Center Experience.

Stroke ◽

10.1161/str.43.suppl_1.a3311 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Tanzila Shams ◽

Jitendra Sharma ◽

Richard Jung ◽

Kristine Blackham

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Prospective Trial ◽

Standard Of Care ◽

The Elderly ◽

Treatment Modalities ◽

Safety And Efficacy ◽

Symptomatic Intracerebral Hemorrhage ◽

All Cause Mortality

Background: In the setting of acute ischemic stroke, endovascular intervention, once considered experimental, is now gold standard of care of appropriately selected patients. Among the elderly, aged 80 and above, patients have multiple comorbidities, and little data exists regarding clinical outcome for those undergoing different endovascular treatment modalities. Objectives: To assess the safety and efficacy of different endovascular treatment modalities in elderly, aged 80 and above, compared to patients younger than 80 with acute ischemic stroke Methods: Restrospective chart review was performed in 150 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2008 and 2011, between age range 17 -93 years. Elderly patients (EP) age 80 and above (n=34) were compared to nonelderly patients age <80 (NEP) (n=116). The patients in both groups underwent mechanical (including MERCI and or Penumbra and/or angioplasty and stenting) and/or chemical thrombolysis (intra-arterial tPA). We compared the specific outcome parameters of EP vs NEP groups, including discharge NIHSS, modified Rankin Scale (mRS), rate of partial to complete recanalization (TIMI 2-3), symptomatic intracerebral hemorrhage (ICH), and all cause mortality. Results: In EP, mean age was 84.9 ± 3.3, with 32.3% (n=11) males and 67.6% (n=23) females. In NEP mean age was 63.6 ± 13.1, with 50.9% (n=59) males and 49.1% (n=57) females. 91.3% (n=106) In EP vs NEP, mean initial NIHSS were 19±7 and 16±6, and discharge NIHSS 9±7 and 12±8, respectively. Rates of recanalization occurred in 67.6% (n=23) in EP, and 71.6% (n=83) in NEP. Discharge mRS 3 or less was 2.9% (n=1) in EP, and 17.2% (n=20) in NEP. Symptomatic ICH occurred in 20.6% (n=7) in EP and 14.7% (n=17) in NEP. All cause mortality rate at discharge in EP group was 41.2% (n=14) and 19.8% (n=23) in NEP. Conclusions: In our experience EP had poor clinical outcomes with increased mortality and hemorrhage rate compared to NEP irrespective of similar recanalization rate. Further prospective trial is warranted to evaluate safety and efficacy of endovascular treatment in patients aged 80 years old and above.

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Intravenous thrombolysis in acute ischemic stroke in the elderly

Neurology India ◽

10.4103/0028-3886.100715 ◽

2012 ◽

Vol 60 (4) ◽

pp. 371

Author(s):

J. M. K. Murthy

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

The Elderly

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Increased Thrombin Generation Is Associated With Acute Ischemic Stroke but Not With Coronary Heart Disease in the Elderly

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.111.223453 ◽

2011 ◽

Vol 31 (6) ◽

pp. 1445-1451 ◽

Cited By ~ 52

Author(s):

Laure Carcaillon ◽

Martine Alhenc-Gelas ◽

Yannick Bejot ◽

Christian Spaft ◽

Pierre Ducimetière ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Thrombin Generation ◽

The Elderly

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Recanalization Treatment of Acute Ischemic Stroke Caused by Large-Artery Occlusion in the Elderly: A Comparative Analysis of “the Elderly” and “the Very Elderly”

Disease Markers ◽

10.1155/2021/3579074 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Qi Wang ◽

Yi-Qun Zhang ◽

Han-Cheng Qiu ◽

Yin-Dan Yao ◽

Ao-Fei Liu ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Acute Ischemic Stroke ◽

The Elderly ◽

Artery Occlusion ◽

Elderly Group ◽

Favorable Outcome ◽

Force Characteristic ◽

Large Artery ◽

Very Elderly

Objective. To assess whether the effectiveness and safety of recanalization therapy for acute ischemic stroke (AIS) caused by large-artery occlusion (LAO) differ between patients aged 60–79 years and patients aged ≥80 years. Methods. We analyzed prospective data of patients with LAO (≥60 years) who underwent recanalization therapy at the Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, from November 2013 to July 2017. The data were compared between elderly patients (60–79 years) and very elderly patients (≥80 years). The effectiveness of recanalization therapy was evaluated using the 90-day modified Rankin scale (mRS) score, while safety was assessed by the rates of symptomatic intracranial hemorrhage (SICH) and mortality within 30 days. Results. A total of 151 patients with AIS induced by LAO were included in this study. Seventy-three patients (48.3% [73/151]) had an overall favorable outcome (mRS score 0–2) after treatment. A higher proportion of patients in the elderly group showed a favorable outcome compared with the very elderly group (58.6% [34/58] vs. 41.6% [39/93], respectively; P = 0.046 ). The incidence of SICH (12.7% vs. 16.13%, respectively; P = 0.561 ) and mortality (10.3% vs. 7.5%, respectively; P = 0.548 ) within 30 days was not significantly different between the two groups. Conclusion. Recanalization treatment of LAO is more effective in elderly patients compared with very elderly patients, while the safety of recanalization treatment is comparable between these two groups.

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