What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=2254). Intervention: Age ≥75 years vs. Age <75 years. Primary outcome: Symptomatic intracranial hemorrhage (SICH) (p=0.04).

November 24, 2011Open Access

Interventional Stroke Therapies in the Elderly: Are We Helping?

Q: What are the key findings of this study?

Patients aged 75 years or older undergoing endovascular therapy for acute ischemic stroke had significantly higher rates of symptomatic intracranial hemorrhage (24% vs 9%) and in-hospital mortality (46% vs 26%) compared to younger patients.

Key Result

Patients aged 75 years or older undergoing endovascular therapy for acute ischemic stroke had significantly higher rates of symptomatic intracranial hemorrhage (24% vs 9%) and in-hospital mortality (46% vs 26%) compared to younger patients.

Study Design

Type

Cohort (n=2,254)

Multicenter

Structured PICO

Are endovascular therapies for acute ischemic stroke safe and effective in patients older than 75 years compared to younger patients?

Population

2,254 patients with acute ischemic stroke, of whom 107 received endovascular therapy, evaluated retrospectively to compare outcomes between patients aged ≥75 years and those <75 years.

Exposure

Endovascular therapies for acute ischemic stroke

Comparator

Younger patients (<75 years) receiving endovascular therapies

Outcome

Rates of endovascular treatment, symptomatic intracranial hemorrhage (SICH), in-hospital mortality, and modified Barthel Index (mBI) at 12 monthshard clinical

Endovascular therapies for acute ischemic stroke in patients ≥75 years are associated with higher rates of symptomatic intracranial hemorrhage, disability, and mortality compared to younger patients.

Main Result

Absolute Event Rate: 24% vs 9%

p-value: p=0.04

Limitations

Single-center retrospective analysis
Non-randomized treatment allocation leading to selection bias
Lack of perfusion imaging to guide patient selection
Did not distinguish between anterior and posterior circulation strokes or specific recanalization methods due to small sample size

Abstract

BACKGROUND AND PURPOSE: It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed. MATERIALS AND METHODS: A retrospective review of patients with AIS 75 years or older (n = 37/1064) was compared with a younger cohort (n = 70/1190) by using an established data base. Admission and discharge NIHSS scores, rates of endovascular treatment, SICH, in-hospital mortality, and the mBI were assessed. RESULTS: Rates of endovascular treatments were significantly lower in older patients (5.9% in the younger-than-75-year versus 3.5% in the older-than-75-year cohort, P = .007). Stroke severity as measured by the NIHSS score was equivalent in the 2 age groups. The mBI at 12 months was worse in the older patients (mild or no disability in 52% of the younger-than-75-year and 22% in the 75-year-or-older cohort, P = .006). Older patients had higher rates of SICH (9% in younger-than-75-year versus 24% in the 75-year-or-older group, P = .04) and in-hospital mortality (26% in younger-than-75-year versus 46% in the 75-year-or-older group, P = .05). CONCLUSIONS: Patients older than 75 years of age were less likely to receive endovascular treatments. Older patients had higher rates of SICH, disability, and mortality. Prospective randomized trials are needed to determine the criteria for selecting patients most likely to benefit from acute endovascular therapies.

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