Influence of age on clinical and revascularization outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry

Alicia C Castonguay; Osama O Zaidat; Roberta Novakovic; Thanh N Nguyen; M Asif Taqi; Rishi Gupta; Chung-Huan J Sun; Coleman Martin; William E Holloway; Nils Mueller-Kronast; Joey E English; Italo Linfante; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Michael G Abraham; Vallabh Janardhan; Hashem Shaltoni; Albert J Yoo; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Ritesh Kaushal; Ashish Nanda; Mohammad A Issa; Raul G Nogueira

doi:10.1161/STROKEAHA.114.006487

Influence of age on clinical and revascularization outcomes in the North American Solitaire Stent-Retriever Acute Stroke Registry

Stroke. 2014 Dec;45(12):3631-6. doi: 10.1161/STROKEAHA.114.006487. Epub 2014 Oct 30.

Authors

Alicia C Castonguay¹, Osama O Zaidat², Roberta Novakovic¹, Thanh N Nguyen¹, M Asif Taqi¹, Rishi Gupta¹, Chung-Huan J Sun¹, Coleman Martin¹, William E Holloway¹, Nils Mueller-Kronast¹, Joey E English¹, Italo Linfante¹, Guilherme Dabus¹, Tim W Malisch¹, Franklin A Marden¹, Hormozd Bozorgchami¹, Andrew Xavier¹, Ansaar T Rai¹, Michael T Froehler¹, Aamir Badruddin¹, Michael G Abraham¹, Vallabh Janardhan¹, Hashem Shaltoni¹, Albert J Yoo¹, Alex Abou-Chebl¹, Peng R Chen¹, Gavin W Britz¹, Ritesh Kaushal¹, Ashish Nanda¹, Mohammad A Issa¹, Raul G Nogueira¹

Affiliations

¹ From the Departments of Neurology (A.C.C., O.O.Z., M.A.I.), Neurosurgery (O.O.Z.), and Radiology (O.O.Z.), Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI; Departments of Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Departments of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.A.T.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S., R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.E.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); Texas Stroke Institute, Plano, TX (V.J., A.A.-C.); University of Texas Health Science Center, Houston, TX (H.S.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.).
² From the Departments of Neurology (A.C.C., O.O.Z., M.A.I.), Neurosurgery (O.O.Z.), and Radiology (O.O.Z.), Medical College of Wisconsin/Froedtert Hospital, Milwaukee, WI; Departments of Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Departments of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.A.T.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S., R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.E.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); Texas Stroke Institute, Plano, TX (V.J., A.A.-C.); University of Texas Health Science Center, Houston, TX (H.S.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.). szaidat@mcw.edu.

PMID: 25358699
DOI: 10.1161/STROKEAHA.114.006487

Abstract

Background and purpose: The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.

Methods: The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into ≤80 and >80 years of age.

Results: Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were ≤80 years and 78 were >80 years of age. Mean age in the ≤80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score ≤2 versus 45.4% ≤80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and ≤80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.

Conclusion: Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.

Keywords: age groups; aged; stroke; thrombectomy.

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Cerebral Angiography
Cerebral Revascularization / methods
Cerebral Revascularization / mortality*
Female
Humans
Male
Mechanical Thrombolysis / methods
Mechanical Thrombolysis / mortality
Middle Aged
North America
Registries
Retrospective Studies
Stroke / mortality
Stroke / surgery*
Treatment Outcome
Young Adult