Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry

Alicia C. Castonguay; Osama O. Zaidat; Roberta Novakovic; Thanh N. Nguyen; M. Asif Taqi; Rishi Gupta; Chung Huan J Sun; Coleman Martin; William E. Holloway; Nils Mueller-Kronast; Joey E. English; Italo Linfante; Guilherme Dabus; Tim W. Malisch; Franklin A. Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T. Rai; Michael T. Froehler; Aamir Badruddin; Michael G. Abraham; Vallabh Janardhan; Hashem Shaltoni; Albert J. Yoo; Alex Abou-Chebl; Peng R. Chen; Gavin W. Britz; Ritesh Kaushal; Ashish Nanda; Mohammad A. Issa; Raul G. Nogueira

doi:10.1161/STROKEAHA.114.006487

Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry

Alicia C. Castonguay, Osama O. Zaidat, Roberta Novakovic, Thanh N. Nguyen, M. Asif Taqi, Rishi Gupta, Chung Huan J Sun, Coleman Martin, William E. Holloway, Nils Mueller-Kronast, Joey E. English, Italo Linfante, Guilherme Dabus, Tim W. Malisch, Franklin A. Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler, Aamir BadruddinMichael G. Abraham, Vallabh Janardhan, Hashem Shaltoni, Albert J. Yoo, Alex Abou-Chebl, Peng R. Chen, Gavin W. Britz, Ritesh Kaushal, Ashish Nanda, Mohammad A. Issa, Raul G. Nogueira

Research output: Contribution to journal › Article › peer-review

65 Scopus citations

Abstract

Background and Purpose - The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.

Methods - The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into =80 and >80 years of age.

Results - Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were =80 years and 78 were >80 years of age. Mean age in the =80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score =2 versus 45.4% =80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and =80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.

Conclusion - Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.

Original language	English (US)
Pages (from-to)	3631-3636
Number of pages	6
Journal	Stroke
Volume	45
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.114.006487
State	Published - Dec 11 2014

Keywords

Age groups
Aged
Stroke
Thrombectomy

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialized Nursing

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10.1161/STROKEAHA.114.006487

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Castonguay, A. C., Zaidat, O. O., Novakovic, R., Nguyen, T. N., Taqi, M. A., Gupta, R., Sun, C. H. J., Martin, C., Holloway, W. E., Mueller-Kronast, N., English, J. E., Linfante, I., Dabus, G., Malisch, T. W., Marden, F. A., Bozorgchami, H., Xavier, A., Rai, A. T., Froehler, M. T., ... Nogueira, R. G. (2014). Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry. Stroke, 45(12), 3631-3636. https://doi.org/10.1161/STROKEAHA.114.006487

Castonguay, AC, Zaidat, OO, Novakovic, R, Nguyen, TN, Taqi, MA, Gupta, R, Sun, CHJ, Martin, C, Holloway, WE, Mueller-Kronast, N, English, JE, Linfante, I, Dabus, G, Malisch, TW, Marden, FA, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Abraham, MG, Janardhan, V, Shaltoni, H, Yoo, AJ, Abou-Chebl, A, Chen, PR, Britz, GW, Kaushal, R, Nanda, A, Issa, MA & Nogueira, RG 2014, 'Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry', Stroke, vol. 45, no. 12, pp. 3631-3636. https://doi.org/10.1161/STROKEAHA.114.006487

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title = "Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry",

abstract = "Background and Purpose - The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.Methods - The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into =80 and >80 years of age.Results - Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were =80 years and 78 were >80 years of age. Mean age in the =80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score =2 versus 45.4% =80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and =80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.Conclusion - Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.",

keywords = "Age groups, Aged, Stroke, Thrombectomy",

author = "Castonguay, {Alicia C.} and Zaidat, {Osama O.} and Roberta Novakovic and Nguyen, {Thanh N.} and Taqi, {M. Asif} and Rishi Gupta and Sun, {Chung Huan J} and Coleman Martin and Holloway, {William E.} and Nils Mueller-Kronast and English, {Joey E.} and Italo Linfante and Guilherme Dabus and Malisch, {Tim W.} and Marden, {Franklin A.} and Hormozd Bozorgchami and Andrew Xavier and Rai, {Ansaar T.} and Froehler, {Michael T.} and Aamir Badruddin and Abraham, {Michael G.} and Vallabh Janardhan and Hashem Shaltoni and Yoo, {Albert J.} and Alex Abou-Chebl and Chen, {Peng R.} and Britz, {Gavin W.} and Ritesh Kaushal and Ashish Nanda and Issa, {Mohammad A.} and Nogueira, {Raul G.}",

year = "2014",

month = dec,

day = "11",

doi = "10.1161/STROKEAHA.114.006487",

language = "English (US)",

volume = "45",

pages = "3631--3636",

journal = "Stroke",

issn = "0039-2499",

publisher = "American Heart Association",

number = "12",

}

TY - JOUR

T1 - Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry

AU - Castonguay, Alicia C.

AU - Zaidat, Osama O.

AU - Novakovic, Roberta

AU - Nguyen, Thanh N.

AU - Taqi, M. Asif

AU - Gupta, Rishi

AU - Sun, Chung Huan J

AU - Martin, Coleman

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey E.

AU - Linfante, Italo

AU - Dabus, Guilherme

AU - Malisch, Tim W.

AU - Marden, Franklin A.

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar T.

AU - Froehler, Michael T.

AU - Badruddin, Aamir

AU - Abraham, Michael G.

AU - Janardhan, Vallabh

AU - Shaltoni, Hashem

AU - Yoo, Albert J.

AU - Abou-Chebl, Alex

AU - Chen, Peng R.

AU - Britz, Gavin W.

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Issa, Mohammad A.

AU - Nogueira, Raul G.

PY - 2014/12/11

Y1 - 2014/12/11

N2 - Background and Purpose - The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.Methods - The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into =80 and >80 years of age.Results - Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were =80 years and 78 were >80 years of age. Mean age in the =80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score =2 versus 45.4% =80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and =80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.Conclusion - Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.

AB - Background and Purpose - The Solitaire With the Intention for Thrombectomy (SWIFT) and thrombectomy revascularization of large vessel occlusions in acute ischemic stroke (TREVO 2) trial results demonstrated improved recanalization rates with mechanical thrombectomy; however, outcomes in the elderly population remain poorly understood. Here, we report the effect of age on clinical and angiographic outcome within the North American Solitaire-FR Stent-Retriever Acute Stroke (NASA) Registry.Methods - The NASA Registry recruited sites to submit data on consecutive patients treated with Solitaire-FR. Influence of age on clinical and angiographic outcomes was assessed by dichotomizing the cohort into =80 and >80 years of age.Results - Three hundred fifty-four patients underwent treatment in 24 centers; 276 patients were =80 years and 78 were >80 years of age. Mean age in the =80 and >80 cohorts was 62.2±13.2 and 85.2±3.8 years, respectively. Of patients >80 years, 27.3% had a 90-day modified Rankin Score =2 versus 45.4% =80 years (P=0.02). Mortality was 43.9% and 27.3% in the >80 and =80 years cohorts, respectively (P=0.01). There was no significant difference in time to revascularization, revascularization success, or symptomatic intracranial hemorrhage between the groups. Multivariate analysis showed age >80 years as an independent predictor of poor clinical outcome and mortality. Within the >80 cohort, National Institutes of Health Stroke Scale (NIHSS), revascularization rate, rescue therapy use, and symptomatic intracranial hemorrhage were independent predictors of mortality.Conclusion - Greater than 80 years of age is predictive of poor clinical outcome and increased mortality compared with younger patients in the NASA registry. However, intravenous tissue-type plasminogen activator use, lower NIHSS, and shorter revascularization time are associated with better outcomes. Further studies are needed to understand the endovascular therapy role in this cohort compared with medical therapy.

KW - Age groups

KW - Aged

KW - Stroke

KW - Thrombectomy

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VL - 45

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EP - 3636

JO - Stroke

JF - Stroke

SN - 0039-2499

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ER -

Influence of age on clinical and revascularization outcomes in the North American solitaire stent-retriever acute stroke registry

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