Key result
Age ≥72 years is linked to ~2.2-fold higher odds of poor 90-day post-thrombectomy outcome.
Why the study?
An easy scoring system to predict the risk of poor outcome after mechanical thrombectomy among the elderly is currently not available.
Does age ≥ 72 years and a 5-variable clinical nomogram predict poor 90-day functional outcome in acute ischemic stroke patients undergoing mechanical thrombectomy, and how does thrombus histological composition differ by age?
Cohort (n=304)
Pathologists analyzing thrombi were blinded to clinical data and imaging findings
No
Does age ≥ 72 years and a 5-variable clinical nomogram predict poor 90-day functional outcome in acute ischemic stroke patients undergoing mechanical thrombectomy, and how does thrombus histological composition differ by age?
Provides a validated 5-variable nomogram (AUC 0.803) for individualized risk prediction of poor 90-day functional outcome after mechanical thrombectomy in elderly stroke patients (≥72 years) and demonstrates higher fibrin content in thrombi from older patients.
Answers are grounded in this paper and cite their sources.
Supports nomogram-based risk stratification in elderly thrombectomy patients; leaves open prospective validation before routine adoption.
An easy scoring system to predict the risk of poor outcome after mechanical thrombectomy among the elderly is currently not available. Therefore, we aimed to develop a nomogram for predicting the probability of negative prognosis in aged patients with acute ischemic stroke undergoing thrombectomy. In addition, we sought to investigate the association between histological thrombus composition and stroke characteristics. To this end, we prospectively studied a developed cohort using data collected from a stroke center from November 2015 to December 2019. The main outcome was functional independence, defined as a modified Rankin Scale score ≤ 2 at 90 days following a mechanical thrombectomy. A nomogram model based on multivariate logistic models was generated. The retrieved thrombi were stained with hematoxylin and eosin and assessed according to histological composition. Our results demonstrated that age ≥ 72 years was independently associated with poor outcome. A total of 304 participants completed the follow-up data to generate the nomogram model. After multivariate logistic regression, five variables remained independent predictors of outcome, including older age, hemorrhagic transformation, thrombolysis in cerebral infarction score, National Institute of Health Stroke score, and neutrophil-to-lymphocyte ratio, and were used to generate the nomogram. The area under the receiver-operating characteristic curve of the model was 0.803. The clots from elderly subjects with large-artery atherosclerosis, anterior circulation, and successful recanalization groups had a higher percentage of fibrin compared to those of younger patients. This is the first nomogram to be developed and validated in a stroke center cohort for individualized prediction of poor outcome in elderly patients after mechanical thrombectomy. Clot composition provides valuable information on the underlying pathogenesis of oxidation in older patients.
No takes yet. Share an insight, caveat, or question.
Meng et al. (2020) conducted a cohort in Acute ischemic stroke due to large vessel occlusion undergoing mechanical thrombectomy (n=304). Older age (≥ 72 years) at mechanical thrombectomy vs. Younger age (< 72 years) at mechanical thrombectomy was evaluated on Poor functional outcome ( vs. functional independence defined as modified Rankin Scale score ≤ 2) at 90 days (OR 2.25, 95% CI 1.20-4.25, p=0.012). Age ≥72 years independently predicted poor 90-day outcome after mechanical thrombectomy (OR 2.25, 95% CI 1.20–4.25), and a 5-variable nomogram achieved an AUC of 0.803.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: