80歳以上の高齢者に対する急性期血栓回収術の治療転帰

抄録

Objective: We compared the effect of endovascular treatment for acute ischemic stroke between patients aged >80 years and those aged <80 years.

Patients and Methods: A total of 37 consecutive patients underwent mechanical thrombectomy between July 2014 and November 2016. Patients were divided into 2 groups by age, those aged >80 years (n = 16) and those aged <80 years (n = 21).

Results: There were no significant differences between the two groups regarding preprocedural computed tomography (CT) Alberta Stroke Programme Early CT Score (ASPECTS) (9.1 vs. 8.7), National Institutes of Health Stroke Scale (NIHSS) (20.5 vs. 19.2), and previous intravenous administration of alteplase (56.3% vs. 61.9%). Successful recanalization (Thrombolysis in Cerebral Infarction〔TICI〕 grade 2b, 3) was achieved in 87.5% patients aged >80 years and 81.0% patients aged <80 years. However, the rate of favorable outcomes, such as modified Rankin Scale score of 0-2 at 90 days after stroke, was significantly lower in patients aged >80 years than in those aged <80 years (12.5% vs. 52.4%). In addition, the complication rate, including heart failure, aspiration pneumonia, and urinary infection, was much higher in patients aged >80 years than in those aged <80 years.

Conclusion: Mechanical thrombectomy is safe and effective for acute ischemic stroke, even in patients aged >80 years. However, the clinical outcomes in patients aged >80 years were poorer than those in aged <80 years. A higher incidence of general complications was associated with a poorer prognosis in elderly patients.