Journal article
Outcomes of endovascular thrombectomy in patients selected by computed tomography perfusion imaging - a matched cohort study comparing nonagenarians to younger patients
Journal of neurointerventional surgery, v 14(8), pp 747-751
01 Aug 2022
PMID: 34475251
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Endovascular thrombectomy (EVT) is efficacious for appropriately selected patients with large vessel occlusions (LVO) up to 24 hours from symptom onset. There is limited information on outcomes of nonagenarians, selected with computed tomography perfusion (CTP) imaging. Methods We retrospectively analyzed data from a large academic hospital between December 2017 and October 2019. Patients receiving EVT for anterior circulation LVO were stratified into nonagenarian (>= 90 years) and younger (<90 years) groups. We performed propensity score matching on 18 covariates. In the matched cohort we compared: primary outcome of inpatient mortality and secondary outcomes of successful reperfusion (TICI >= 2B), symptomatic intracranial hemorrhage (sICH), and functional independence. Subgroup analysis compared CTP predicted core volumes in nonagenarians with outcomes. Results Overall, 214 consecutive patients (26 nonagenarians, 188 younger) underwent EVT. Nonagenarians were aged 92.8 +/- 2.9 years and younger patients were 74.5 +/- 13.5 years. Mortality rate was significantly greater in nonagenarians compared with younger patients (43.5% vs 10.4%, OR 9.33, 95% CI 2.88 to 47.97, P<0.0001) and a greater proportion of nonagenarians developed sICH (13.0% vs 3.0%, OR 6.00, 95% CI 1.34 to 55.20, P=0.02). There were no significant differences for successful reperfusion (P=1.00) or functional independence (P=0.75). Nonagenarians selected with smaller ischemic core volumes had decreased mortality rates (P=0.045). Conclusions Nonagenarians were noted to have greater mortality and sICH rates following EVT compared with matched younger patients, which may be ameliorated by selecting patients with smaller CTP core volumes. Nonagenarians undergoing EVT had similar rates of successful reperfusion and functional independence compared with the younger cohort.
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Details
- Title
- Outcomes of endovascular thrombectomy in patients selected by computed tomography perfusion imaging - a matched cohort study comparing nonagenarians to younger patients
- Creators
- Rahul Rahangdale - Allegheny Health NetworkChristopher Todd Hackett - Allegheny Hlth Network, Neurol, Pittsburgh, PA 15222 USARussell Cerejo - Allegheny Health NetworkNicholas M. Fuller - Allegheny Health NetworkKonark Malhotra - Allegheny Health NetworkRichard Williamson - Allegheny Health NetworkTerry Hentosz - Allegheny Health NetworkAshis H. Tayal - Allegheny Health NetworkSandeep S. Rana - Allegheny Health Network
- Publication Details
- Journal of neurointerventional surgery, v 14(8), pp 747-751
- Publisher
- Bmj Publishing Group
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000725046000001
- Scopus ID
- 2-s2.0-85134433191
- Other Identifier
- 991021959050204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Neuroimaging
- Surgery