Abstract Details

Title Clinical Outcomes following Endovascular Therapy and/or Thrombolysis in Elderly with Large Vessel Occlusion Strokes: A “Real World” Experience

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-007

Objective To investigate clinical outcomes in elderly AIS patients with LVO treated with acute stroke therapies compared to standard medical therapy.

Background Elderly patients (above 80 years old) are largely excluded from, or at least underrepresented, in many randomized clinical trials investigating treatment efficacy in acute ischemic stroke (AIS). As such, the tendency to exclude AIS patients with large vessel occlusion (LVO) from treatment with endovascular therapy (EVT) based on advanced age alone is not supported by current evidence.

Design/Methods This was a retrospective review of elderly AIS patients with LVO treated at our institution from 2009-2018 stratified by treatment group; EVT, tPA, combined EVT/tPA or medical management. In this sample, we compared discharge mortality, post-treatment hemorrhage rates and Modified Rankin Scale (mRS) at discharge between treatment groups.

Results We identified n=65 elderly AIS patients with LVO who received acute treatment (n=28 EVT, n=26 tPA, and n= 11 both EVT and tPA). We also identified n=66 patients, matched for age, sex, NIHSS, medical comorbidities who did not receive any acute treatment. Mortality rates were significantly lower in the treated group compared to medical management (35 vs. 57%, p = 0.014); however, a significantly higher percentage of treated patients developed symptomatic hemorrhage after treatment as compared to medical management (25 vs. 6%, p = 0.003). Overall, a significantly higher proportion of patients who were treated had a favorable outcome (no death, no hemorrhage, mRS 0-3) compared to medical management (61 vs. 38%, p=0.013).

Conclusions These results suggest a significant survival benefit in the treated group over the medical management group. Furthermore, this advantage holds true even though the treated group experienced significantly higher hemorrhage rates. While this study was retrospective in nature and small in sample size, it provides evocative evidence for reexamination of exclusion from acute AIS treatment, solely based on advanced age.

Authors/Disclosures
Tamra I. Ranasinghe, MD PRESENTER	Dr. Ranasinghe has nothing to disclose.
Ashley Petrone	No disclosure on file
Amelia K. Adcock, MD (WVU School of Medicine, Dept. of Neurology)	The institution of an immediate family member of Dr. Adcock has received research support from NIH.

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