Endovascular treatment for acute ischemic stroke in octogenarians compared with younger patients: a meta-analysis

被引:41
作者
Duffis, E. Jesus [1 ,2 ]
He, Wenzhuan [2 ]
Prestigiacomo, Charles J. [1 ,2 ,3 ]
Gandhi, Chirag D. [1 ,3 ]
机构
[1] Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Neurol Surg, Newark, NJ 07103 USA
[2] Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Neurosci, Newark, NJ 07103 USA
[3] Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Radiol, Newark, NJ 07103 USA
关键词
elderly; endovascular; ischemic stroke; thrombolysis; INTRAARTERIAL THROMBOLYSIS; MECHANICAL THROMBECTOMY; LEUKOARAIOSIS; OLDER;
D O I
10.1111/ijs.12098
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Little is known about the safety and efficacy of endovascular therapy for acute ischemic stroke in octogenarians. Aim We performed a systematic review and meta-analysis of published studies comparing outcomes of octogenarians and younger patients after endovascular treatment for acute ischemic stroke. Methods A computerized search of the medical literature from 1990 to 2012 was performed to identify comparative studies of endovascular treatment of ischemic stroke patients 80 years or older and younger patients. Data on clinical outcomes, mortality, symptomatic intracerebral hemorrhage, and recanalization were abstracted. Results Data from eight studies with 2729 patients were included in the final analysis. Good functional outcome defined as modified Rankin score 2 or less within 90 days was more common in younger patients compared with octogenarians [odds ratio 2.694; 95% confidence interval 1.941-3.740, P < 0.001). Symptomatic hemorrhage and death were significantly more come in patients 80 years or older (odds ratio 1.604; 95% confidence interval 1.013-2.540, P = 0.04 and odds ratio 3695; 95% confidence interval 2.517-5.424, P < 0.001, respectively). Successful recanalization defined as Thrombolysis in Myocardial Infarction (TIMI) 2-3 was seen less frequently in older patients; however, this did not reach statistical significance (odds ratio 0.814; 95% confidence interval 0.522-1.269, P = 0.364). Conclusion Formal meta-analysis showed that octogenarians are less likely to achieve functional independence and have higher rates of mortality and intracerebral hemorrhage following endovascular treatment for ischemic stroke compared with younger patients. Decisions regarding endovascular treatment of elderly patients should be individualized until randomized controlled trials are available.
引用
收藏
页码:308 / 312
页数:5
相关论文
共 20 条
[1]   Multimodal Reperfusion Therapy for Large Hemispheric Infarcts in Octogenarians: Is Good Outcome a Realistic Goal? [J].
Arkadir, D. ;
Eichel, R. ;
Gomori, J. M. ;
Ben Hur, T. ;
Cohen, J. E. ;
Leker, R. R. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2012, 33 (06) :1167-1169
[2]   Intravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of age [J].
Bhatnagar, Pallav ;
Sinha, Devesh ;
Parker, Richard A. ;
Guyler, Paul ;
O'Brien, Anthony .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2011, 82 (07) :712-717
[3]   Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century [J].
Feigin, VL ;
Lawes, CMM ;
Bennett, DA ;
Anderson, CS .
LANCET NEUROLOGY, 2003, 2 (01) :43-53
[4]  
GHOBRIAL GM, 2012, J NEUROINTERVENT S1, P33
[5]   Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke [J].
Hacke, Werner ;
Kaste, Markku ;
Bluhmki, Erich ;
Brozman, Miroslav ;
Davalos, Antoni ;
Guidetti, Donata ;
Larrue, Vincent ;
Lees, Kennedy R. ;
Medeghri, Zakaria ;
Machnig, Thomas ;
Schneider, Dietmar ;
von Kummer, Ruediger ;
Wahlgren, Nils ;
Toni, Danilo .
NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (13) :1317-1329
[6]  
Kim D, 2007, AM J NEURORADIOL, V28, P159
[7]  
KIM WJ, 2012, KOREAN J STROKE, V14, P19
[8]   Higher Rates of Mortality but Not Morbidity Follow Intracranial Mechanical Thrombectomy in the Elderly [J].
Loh, Y. ;
Kim, D. ;
Shi, Z. -S. ;
Tateshima, S. ;
Vespa, P. M. ;
Gonzalez, N. R. ;
Starkman, S. ;
Saver, J. L. ;
Jahan, R. ;
Liebeskind, D. S. ;
Duckwiler, G. R. ;
Vinuela, F. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2010, 31 (07) :1181-1185
[9]   Impact of a Combined Intravenous/Intra-Arterial Approach in Octogenarians [J].
Mazighi, Mikael ;
Labreuche, Julien ;
Meseguer, Elena ;
Serfaty, Jean-Michel ;
Laissy, Jean-Pierre ;
Lavallee, Philippa C. ;
Cabrejo, Lucie ;
Guidoux, Celine ;
Lapergue, Bertrand ;
Klein, Isabelle F. ;
Olivot, Jean-Marc ;
Abboud, Halim ;
Simon, Olivier ;
Schouman-Claeys, Elisabeth ;
Amarenco, Pierre .
CEREBROVASCULAR DISEASES, 2011, 31 (06) :559-565
[10]   Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive [J].
Mishra, Nishant K. ;
Ahmed, Niaz ;
Andersen, Grethe ;
Egido, Jose A. ;
Lindsberg, Perttu J. ;
Ringleb, Peter A. ;
Wahlgren, Nils G. ;
Lees, Kennedy R. .
BMJ-BRITISH MEDICAL JOURNAL, 2010, 341 :1144