Does Age Impact Post-Mechanical Thrombectomy Outcomes in Acute Ischemic Stroke?

Mechanical thrombectomy outcomes at 1-year are strongly related to patient age among those treated for acute ischemic stroke, according to study findings published in the Journal of Neurology, Neurosurgery & Psychiatry.

Mechanical thrombectomy has been reported as highly effective for the treatment of acute ischemic stroke due to proximal large artery occlusion. However, trials evaluating the efficacy and safety of mechanical thrombectomy have had relatively short follow-up durations and a small proportion of study populations who were older than 80 years old.

Researchers designed the study to evaluate longer-term outcomes for older patients who underwent mechanical thrombectomy. To that end, the researchers retrospectively evaluated real-world data from the German remuneration system. Patients (N=18,506) who underwent mechanical thrombectomy between 2010 and 2018 were assessed for outcomes between 1 and 9 years (median, 42.7 months) on the basis of age.

The patients were median age, 76 (Interquartile range [IQR], 11) years; 55.8% were women; 88.7% had hypertension; 63.0% dyslipidemia; 53.4% atrial fibrillation; and 39.0% diabetes.

Stratified by age, 16.2% were younger than 60 years; 16.5% were between 60-69 years, 30.9% were between 70-79 years; 18.8% were between 80-84 years, 12.4% were between 85-89 years, and 5.1% were 90 years and older. In general, patients who were 80 years and older, compared with younger patients, were more likely to have comorbidities and were need of outpatient or nursing home care prior to ischemic stroke.

During hospitalization for the stroke event, 44.1% received systemic thrombolysis, 24.8% received ventilation for more than 48 hours, and 26.4% had in-hospital mortality.

During follow-up, survival rates decreased with age, in which 1-year mortality was 55.4% among those who were older than 80 years compared with 19.3% for the entire population. Patients who were older than 80 years had lower rates of no or slight disability at 1 year compared with younger patients (17.4% vs 41.0%) and higher rates of moderate to severe disability (35.5% vs 33.2%), respectively.

Among the patients aged over 80 years, increased mortality was associated with receipt of ventilation for over 48 hours (adjusted hazard ratio [aHR], 2.91), chronic limb-threatening ischemia (aHR, 1.59), diabetes (aHR, 1.44), previous acute myocardial infarction (aHR, 1.37), dementia (aHR, 1.29), and chronic kidney disease (adjusted HR [aHR], 1.26).

Moderate to severe disability risk among older patients associated with dementia (HR, 1.77), diabetes (HR, 1.25), chronic limb-threatening ischemia (HR, 1.19), receipts of more than 48 hours of ventilation (HR, 1.15), and chronic kidney disease (HR, 1.13).

Similarly, risk for requiring post-stroke nursing home care included dementia (HR, 1.48), receipt of ventilation for over 48 hours (HR, 1.40), diabetes (HR, 1.16), and chronic kidney disease (HR, 1.08).

The major limitation of this study was the lack of a control group, such as patients who had a large vessel occlusion stroke without undergoing mechanical thrombectomy.

Researchers concluded, “[T]his cohort study demonstrates that outcomes after mechanical thrombectomy were strongly associated with age. Patients aged 80 years and older undergoing mechanical thrombectomy were dead in more than half of the cases and less than one-fifth were functionally independent at 1-year follow-up compared with younger patients.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Neurology Advisor