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Laurent SPELLE – May 25, 2013
“You are un 2005!... No flow diverter!...”
Eduardo Wajnberg – May 24, 2013
“My opinion is that it would be worth putting a flow diverter through the neck of the aneurysm. A...”
mohd shafie abdullah – April 26, 2013
“I'm thinking of deploying telescoping approach of 2 Leos and jailing technique with loose packing...”
Pakrit Jittapiromsak – April 16, 2013
“Thank you for your comment. Honestly, in my experience, if the stent(s) is(are) placed and oppose...”
Steve Dechan – April 13, 2013
“Just a question please, there are reports of instent restenosis at the distal and proximal ends o...”
Interventional Stroke Therapies in the Elderly: Are We Helping?
American Journal of Neuroradiology by
- Authors: N. Zeevi, G.A. Kuchel, N.S. Lee, I. Staff and L.D. McCullough
- Reference: AJNR Am J Neuroradiol 2012 33: 638-642
- Published: November 2011
- Link: Access the abstract here
This is a retrospective study collecting patients with acute ischemic stroke treated in a single stroke center between 2005 and 2009. A total of 2254 patients were collected. The data were stratified in 2 age groups to define elderly: younger group, <75 (n=1190) or older group, ≥75 (n=1064). Endovascular treatment was performed under institutional criteria in 70 cases in younger group and 37 cases in older group.
No significant difference in medication taken between groups. The older group has higher incidence of hypertension and atrial fibrillation. The median baseline modified Barthel Index (mBI) was significantly lower in older group (20 vs. 19).
Recanalization was achieved equally in between groups (68% vs. 79%).
The immediate outcome measured by decreasing in NIHSS score ≥4 showed non-significance between groups (70% vs. 82%). Significant worse in symptomatic intracranial hemorrhage (ICH) and in-hospital mortality was observed in older group (9% vs. 24% and 26% vs. 46%, respectively). The long-term outcome measured by mBI ≥15 revealed significant inferior in older group (51% vs. 28% at 3 months and 52% vs. 22% at 1 year, p<0.05).
These findings indicate limitation in endovascular treatment in elderly patients. Pretreatment condition is usually worse than younger patient. Significant risks of symptomatic ICH and mortality are the main concern. Additionally, less improvement of neurological function in elderly is a known issue. Angiographic outcome alone is not sufficient to satisfy the patients and relatives.