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Master Thesis

Thrombolysis and mechanical thrombectomy for acute ischemic stroke in octogenarian patients: a regional observational study

Abstract : Introduction: Elderly patients represent a growing stroke population characterized by a higher frailty, underrepresented in randomized trials. We investigated safety, effectiveness and prognostic factors of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in this age group. Methods: Retrospective analysis of a regional stroke-unit registry of consecutive acute ischemic stroke (AIS) patients between 2014 and 2019. We compared clinical characteristics, mortality, and functional outcome between <80 years (<80y) and ≥80 years old patients (≥80y). We described the subgroup of nonagenarians patients. Results: Number of IVT and MT performed in > 80y increase of 30 in 2014 to 173 in 2019. After IVT and/or MT, ≥80y have a significantly lower likelihood of functional independence (defined as a modified rankin scale score of 0–2) at discharge (34.1% vs 60.8%, P<0.001) and between 3-6 months (18.1% vs 43.1% p<0.001) compared with the < 80y. Mortality rate was significantly higher in the ≥80y compared <80y (21.1% vs 5.6%, p < 0.001). For patients undergoing IVT and/or MT, age of ≥80 years and a high initial NIHSS score are poor prognostic factors. There is no significant difference with likelihood of functional independence or mortality between octogenarians and nonagenarians. Discussion: The number ≥ 80y admitted to stroke unit has doubled in 6 years, with a number of recanalization procedures multiplied by 5. IVT and MT in AIS management are feasible in octogenarians but functional outcome remains poor compared younger patients. Studies including more octogenarians and nonagenarians are needed to better identify patients that would benefit from IVT and MT.
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https://dumas.ccsd.cnrs.fr/dumas-02966637
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Submitted on : Wednesday, October 14, 2020 - 11:16:26 AM
Last modification on : Friday, October 16, 2020 - 3:10:18 AM

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  • HAL Id : dumas-02966637, version 1

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Manon Michelard. Thrombolysis and mechanical thrombectomy for acute ischemic stroke in octogenarian patients: a regional observational study. Human health and pathology. 2020. ⟨dumas-02966637⟩

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