Abstract Details

Title Older Age Is Associated with Frequent Clinical-core Mismatch in Stroke due to Anterior Circulation Large Vessel Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-028

Objective To define the relationship between older age and clinical core mismatch (CCM) among patients with acute anterior circulation large vessel occlusion (ACLVO) stroke.

Background Older ACLVO stroke patients experience worse functional outcomes. Presence of CCM indicates discordance of clinical severity and ischemic core volume, suggesting salvageable penumbra on hospital arrival. However, the impact of older age on CCM is unclear.

Design/Methods Retrospective study of patients with acute intracranial ICA or MCA occlusion in 2014-2019, included if they had baseline advanced imaging within 24 hours after last known well (LKW) time. Prevalence of CCM1 (NIHSS ≥ 10 and core ≤20 ml) and CCM2 (NIHSS ≥10 and core ≤31 ml) were compared across age tertiles and LKW to imaging time (LKWT: 0-24, ≤6 or 6-24 hours). Multivariable logistic regression tested the association between age and CCM, adjusted for LKWT, sex and vascular risk factors.

Results 312 patients were included (age tertiles [AT1-3]: 33-66, 67-81, and 82-102 years; 57% women; median NIHSS 17 [IQR, 12-21] and core 12.5 ml [IQR, 0-58]). The CCM prevalence was higher in older age for CCM1 (%: AT1, 33; AT2, 44.6; AT3, 52; P=0.02) and CCM2 (%: AT1, 39; AT2, 47.3; AT3, 56; P=0.055) within 0-24 hours, with similar distribution at ≤6 or 6-24 hours of LKWT. On logistic regression adjusted for LKWT, increasing age (per decade) was associated with CCM-1 (OR 1.27, 95% CI 1.08-1.49, P<0.01) and CCM2 (OR 1.19, 95% CI 1.02-1.39, P=0.02). On multivariable analysis, there was a strong association trend between increasing age (per decade) and CCM-1 (OR 1.2, 95% CI 0.99-1.44, P=0.05) but not CCM2 (OR 1.11, 95% CI 0.92-1.32, P=0.26).

Conclusions Advanced age was associated with higher CCM prevalence in acute ACLVO stroke, independently of early or delayed presentation, supporting the notion that older patients should be given especially careful consideration for endovascular therapies.

Authors/Disclosures
Lucas Rios Rocha, MD (UPMC) PRESENTER	Dr. Rios Rocha has nothing to disclose.
Mohammad N. Kayyali, MD	Dr. Kayyali has nothing to disclose.
Mohamed Fahmy Doheim (University of Pittsburgh)	Mr. Doheim has nothing to disclose.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.
Marcelo Rocha, MD, PhD (UPMC)	The institution of Dr. Rocha has received research support from NIH.

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