Efficacy of revascularization in oldest-old patients with acute ischemic stroke / 中华全科医师杂志

ABSTRACT

Objective@#To analyze the efficacy of revascularization in oldest-old patients with acute ischemic stroke (AIS).@*Methods@#The clinical data of AIS patients receiving recanalization therapy in Beijing Hospital from January 2010 to July 2018 were retrospectively reviewed. Among 141 patients, there were 34 cases aged ≥80 years (oldest-old group) and 107 cases aged<80 years (old group).The clinical characteristics and outcomes of two groups were analyzed and compared.@*Results@#The proportions of patients with atrial fibrillation and coronary heart disease in oldest-old group were high than those in the old group [61.8% (21/34) vs. 33.6%(36/107), χ2=8.47, P<0.01; 58.8% (20/34) vs. 32.7% (35/107), P<0.01, respectively]; while there were no significant differences in other risk factors between two groups (P>0.05). The National Institute of Health Stroke Scale Score (NIHSS) was higher in the oldest-old group than that in old group [16 (13,21) vs. 11 (6,16), Z=3.74, P<0.01]. In the etiological classification, cardiogenic embolism was the main cause in the oldest-old group (58.8%, 20/34), while large artery atherosclerosis was the main cause in the old group (46.7%, 50/107, χ2=12.11, P<0.01). There were no significant differences between the two groups in the methods of recanalization [intravenous thrombolysis were 35.3% (12/34) and 48.6% (52/107); endovascular therapy were 52.9% (18/34) and 36.4% (39/107), bridging therapy were 11.8% (4/34) and 15.0% (16/107), respectively; χ2=2.93,P=0.23] and the time from onset to treatment [195(154, 269) min vs. 215 (153,280)min, Z=1.03, P>0.05]. The 3-month independent (modified Rankin score ≤2) rate was lower in the oldest-old group than that in the old group [35.3% (12/34) vs. 56.1%(60/107), χ2=4.46, P<0.05). The 3-month mortality was higher in the oldest-old group than that in the old group [29.4% (10/34) vs. 8.4%(9/107), χ2=9.76, P<0.01]. There was a tendency of increased incidence of symptomatic intracranial hemorrhage (SICH) in the oldest-old patients compared to the old patients [11.8% (4/34) vs. 7.5% (8/107), P>0.05].@*Conclusion@#The conditions of AIS patients aged ≥80 years are more serious than those of patients aged<80 years, with higher mortality and lower functional improvement rate after recanalization treatment.