E-100\u2005Predictors of unfavorable outcomes in octogenarians receiving mechanical thrombectomy for large vessel occlusion acute ischemic stroke

Abstract

Introduction By 2050, the number of octogenarians will triple that in 2015. Currently over a third of stroke cases occur in patients aged 80 years or older. A better understanding of stroke intervention in octogenarians is warranted considering a rapidly aging population. Here we aimed to identify risk factors predictive of favorable outcomes in octogenarian stroke patients who received mechanical thrombectomy intervention. Materials and methods A retrospective analysis was conducted on all consecutive patients who underwent mechanical thrombectomy between January 2012 to May 2017 at the Gates Vascular Institute in Buffalo, NY. Eighty-eight octogenarian patients with large vessel occlusion were identified. These patients were divided into two groups, those with favorable outcome (mRS 0–2 at 90 days) and those with unfavorable outcome (mRS 3–6 at 90 days). Demographic, procedural, radiographic and outcome data was collected. Variables including but not limited to comorbidities, smoking status, time between symptom onset to hospital arrival, infarct core, initial NIHSS score, admission glucose, creatinine, albumin, IV tPA administration, general anesthesia, procedure type, clot location and etc. were compared between the two groups. Results Of the 88 octogenarian thrombectomies, 29 had favorable 90-day outcome (33%) whereas 59 had unfavorable outcome (67%). Factors that were significantly different between those with favorable and unfavorable outcome include: presence of infarct core before intervention, NIHSS score upon admission and procedure time. Of the 29 favorable outcomes, 5 presented with infarct cores (17%) whereas 30 of the 59 unfavorable outcome patients presented with infarct cores (51%). The median (IQR) NIHSS upon admission for the favorable outcome interventions was 12 (9–15) in contrast to 18 (14–21.5) for unfavorable outcome cases. Mean procedure time for favorable outcomes was 54.02 ± 31.41 minutes compared to 68.04 ±. 30.97 minutes for unfavorable outcomes. Conclusion Our study suggests infarct core, initial NIHSS score and procedure time to be potential predictors of outcome in octogenarian stroke patients receiving mechanical thrombectomy. Additional research is warranted to further evaluate the significance of these predictors. Disclosures F. Chin: None. M. Waqas: None. H. Shallwani: None. H. Rai: None. E. Levy: 1; C; Medtronic US SWIFT PRIME Trials. 2; C; Pulsar Vascular. Advisory Board- Stryker, NeXtGen Biologics, MEDX, Cognition Medical. 4; C; Intratech Medical Ltd., NeXtGen Biologics. 6; C; Abbott Vascular for carotid training sessions. A. Siddiqui: 1; C; Cerenovus LARGE Trial, ARISE II Trial, Medtronic SWIFT PRIME and SWIFT DIRECT Trials, MicroVention FRED Trial & CONFIDENCE Study, MUSC POSITIVE Trial, Penumbra 3D Separator Trial, COMPASS Trial etc. 2; C; Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical. Systems Inc., Cerenovus, Claret Medical, Corindus Inc., Endostream Medical Ltd etc. 4; C; Amnis Therapeutics, Apama Medical, BlinkTBI Inc., Buffalo Technology Partners Inc, Cardinal Health, Cerebrotech Medical Systems Inc, Claret Medical, Coggnition Medical, Endostream Medical Ltd etc.