Abstract
Objective: We retrospectively analyzed the efficacy of interventional revascularization therapy in very elderly patients with acute stroke.
Methods: Patients undergoing acute revascularization therapy between July 2010 and January 2013 in our hospital were retrospectively analyzed. Age, sex, infarcted side, risk factors for ischemic stroke, National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT score-diffusion weighted imaging (ASPECTS-DWI) score, types of infarction, occlusion with or without intravenous administration of tissue-type plasminogen activator (IV-tPA), devices used, time course, effectiveness of revascularization (Thrombolysis in Cerebral Infarction; TICI 2a or more than TICI 2b), complications, and functional outcome were compared among elderly (>75 years/old; y/o) and nonelderly (≤75 y/o) patients.
Results: Combination therapy with IV-tPA was performed for 21 (46%) patients. The median NIHSS score upon arrival at the hospital was 18 and the median ASPECTS-DWI score before treatment was 7. There was no difference in the puncture to revascularization time between the two groups. We achieved an effective revascularization for 30 patients (9 elderly, 21 non-elderly). Other than age, there was no significant difference in any of the patient characteristics between the two groups. Major complications were symptomatic cerebral hemorrhage in 1 patient of the non-elderly group and asymptomatic subarachnoid hemorrhage in 5 elderly and 9 non-elderly patients. Good functional recovery (modified Rankin Scale; mRS ≤3) at discharge was seen in 7 elderly (47%) and 13 (42%) non-elderly patients. There was no significant difference in the rate of 0–3 mRS at hospital discharge. After 90 days, 4 elderly (26%) and 3 (10%) non-elderly patients had died. The recanalization rate was equivalent between the non-elderly and elderly.
Conclusions: Acute revascularization by endovascular therapy has the potential to improve functional prognosis in the very elderly following stroke events.