Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients

Key Points Question What are the frequency and outcomes of endovascular thrombectomy therapy in patients aged 80 years and older with acute ischemic stroke? Findings In this cohort study of 302 965 patients with acute ischemic stroke, the frequency of endovascular thrombectomy in patients aged 80 years and older increased from 3.3% in 2012 to 20.8% in 2019. Among endovascular thrombectomy–treated patients, those aged 80 years and older less often achieved functional independence at discharge and more often died or were discharged to hospice care. Meaning The findings of this study suggest that use of endovascular thrombectomy among individuals aged 80 years and older has increased substantially, with few achieving functional independence by discharge.

[1]  D. Hughes,et al.  Predicting 90-day modified Rankin Scale score with discharge information in acute ischaemic stroke patients following treatment , 2021, BMJ Neurology Open.

[2]  T. Morimoto,et al.  Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years , 2021, Stroke.

[3]  Robert D. Brown,et al.  Incidence of Stroke and Ischemic Stroke Subtypes: A Community-Based Study in Brno, Czech Republic. , 2020, Cerebrovascular diseases.

[4]  S. Majidi,et al.  Endovascular thrombectomy in octogenarians and nonagenarians with large vessel occlusion: Technical aspects and clinical outcome. , 2020, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[5]  Hester F. Lingsma,et al.  Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry , 2020, Neurology.

[6]  M. Wiesmann,et al.  Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke , 2020, Journal of the American Heart Association.

[7]  Xuejing Yue,et al.  Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis , 2020, Frontiers in Neurology.

[8]  W. Powers,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. , 2019, Stroke.

[9]  Heather B. Roesly.  Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging , 2018, The Journal of Emergency Medicine.

[10]  E. Lindsay.  Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct , 2018 .

[11]  A. Demchuk,et al.  Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging , 2018, The New England journal of medicine.

[12]  Eric E. Smith,et al.  Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke , 2018, Stroke.

[13]  JAMA Network Open. , 2018, JAMA network open.

[14]  T. Gregório,et al.  Endovascular Stroke Treatment of Patients Over 80 Years Old: Cumulative Evidence from the "Real World". , 2017, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[15]  M. Chen,et al.  NubuckLight Sarto Smooth Smooth Richland Franco Bone Black Nubuck Satin Satin 3 xgZx7qY4 --wildwoodmotorsports.com , 2017 .

[16]  Michael Frankel,et al.  Comparison of 3-Month Stroke Disability and Quality of Life across Modified Rankin Scale Categories , 2016, Interventional Neurology.

[17]  D. Hildick-Smith,et al.  Coronary revascularisation in the elderly , 2016, Heart.

[18]  Eric E. Smith,et al.  Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age , 2016, Stroke.

[19]  A. Demchuk,et al.  Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials , 2016, The Lancet.

[20]  H. Chochinov,et al.  Dignity and Distress towards the End of Life across Four Non-Cancer Populations , 2016, PloS one.

[21]  H. Naess,et al.  Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study , 2015, Acta neurologica Scandinavica.

[22]  B. Rochwerg,et al.  Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis. , 2015, JAMA.

[23]  J. Grotta,et al.  Adopting a Patient-Centered Approach to Primary Outcome Analysis of Acute Stroke Trials Using a Utility-Weighted Modified Rankin Scale , 2015, Stroke.

[24]  Eric E. Smith,et al.  Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): results from a national data validation audit. , 2012, American heart journal.

[25]  Eric E. Smith,et al.  Representativeness of the Get With The Guidelines–Stroke Registry: Comparison of Patient and Hospital Characteristics Among Medicare Beneficiaries Hospitalized With Ischemic Stroke , 2012, Stroke.

[26]  Adrian F Hernandez,et al.  Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke: Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes , 2011, Circulation.

[27]  Elsa Azevedo,et al.  Intravenous Alteplase for Stroke in Those Older Than 80 Years Old , 2010, Stroke.

[28]  K. Lee.  Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack , 2010 .

[29]  Li Liang,et al.  Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack , 2009, Circulation.

[30]  E. D. de Vries,et al.  Prognostic versus predictive value of biomarkers in oncology. , 2008, European journal of cancer.

[31]  R. Kornowski,et al.  Results of percutaneous coronary interventions in patients ≥90 years of age , 2007, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[32]  I. Hallberg.  Death and dying from old people’s point of view. A literature review , 2004, Aging clinical and experimental research.

[33]  B. Gersh,et al.  Epidemiology and natural history of atrial fibrillation: clinical implications. , 2001, Journal of the American College of Cardiology.

[34]  C. Wolfe,et al.  Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group. , 1999, Stroke.

[35]  S. Roth,et al.  Clinical Interventions in Aging , 2022 .