London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 829 913 Interventional neurology Octogenarians should not be excluded from acute stroke endovascular trials as major clinical responses common with reperfusion M.A. Almekhlafi1, S. Mishra2, J. Desai3, V. Nambiar4, O. Volny5, M. Eesa6, B.K. Menon7, A.M. Demchuk8, M. Goyal9, W. Morrish10 University of Calgary - King Abdulaziz Unviersity, Calgary, CANADA1, Unviersity of Calgary, Calgary, 2, Unviersity of Calgary, Calgary, 3, Unviersity of Calgary, Calgary, 4, Unviersity of Cal-gary, Calgary, 5, Unviersity of Calgary, Calgary, 6, Unviersity of Calgary, Calgary, 7, Unviersity of Calgary- HBI, Calgary, 8, University of Calgary - HBI, Calgary, 9,University of Calgary, Calgary, CANADA10 BACKGROUND Octogenarians were excluded from many endovascular acute ischemic stroke trials. This was based on the expected delays in achieving successful reperfusion due to tortuous vascular anatomy and a perceived poor potential for recovery especially in those with existing disability. We sought to assess the safety of the stentrievers technology in this patient population. METHODS This study is part of a longitudinal cohort of acute anterior circulation stroke patients treated in our center between Jan 2011 to Dec 2012. Octogenarians were considered for IA stroke therapy in the absence of a pre-existing disability (Barthel index ≥90) or terminal illness. RESULTS The results are shown in the table. Octogenarians had a non-significant increase in the in-hospital mortality; all occurred in patients who did not reperfuse successfully. In a multivariable logistic regression, age did not impact NIH improvement in 24-hours. There was a non-significant trend to-ward increased puncture-to-reperfusion times with increasing age (p 0.8; figure). CONCLUSION Octogenarians can be treated in a safe and fast manner when selected carefully. The impact of age on long-term functional outcome was not assessed. Excluding these patients from randomized tri-als of acute stroke therapy may need to be revisited given the recent advances in the endovascular reperfusion technology and stroke patients care. Octogenarians Non-octogenarians N 20 66 Median age (iqr) 83 (4) 65 (15) Median baseline NIHSS 17 (11) 18 (9) Median baseline ASPECTS 9 (2.5) 8 (3) Proportion with M1 occlusion 75% 77.3% Proportion treated with IV tPA 60% 47% Median door to imaging 22 (13) 18 (9) Median imaging to puncture 60 (45) 62 (41) Median puncture to reperfusion 42 (38) 39 (31) Median onset to reperfusion 269 (79) 233 (184) Proportion with successful reperfu-sion (TICI 2b-3) 75% 83.3%* Median 24-hour NIHSS 9 (14) 7 (10)† Median 24-hour ASPECTS 8 (4) 6 (3)† Median NIH drop in 24 hours 7 (6) 10 (10) Proportion with 50% or more drop in NIH in 24 hours 47% 58.5%* In-hospital mortality 15% 6%* * Chi-square p >0.05 †U test p-value>0.05 Interventional neurology (PO 913 - 955)
Karger_ESC London_2013
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