高龄急性大血管闭塞性卒中患者取栓治疗的特点及疗效研究

目的 研究高龄急性大血管闭塞性卒中患者动脉内取栓治疗的特点及疗效.方法 回顾性连续纳入2018年1月至2021年8月解放军战略支援部队特色医学中心神经内科收治的诊断为急性大血管闭塞并接受动脉内取栓治疗的卒中患者.年龄均≥18岁,根据患者年龄分为两组:高龄组(年龄≥80岁)以及低龄组(年龄<80岁).详尽收集患者基线资料...

Characteristics and outcomes of endovascular treatment in the elderly with acute large vessel occlusion stroke

Objective To study the characteristics and outcomes of endovascular treatment(EVT)in the elderly with acute large vessel occlusion stroke(ALVOS).Methods From January 2018 to August 2021,stroke patients diagnosed with ALVOS and treated with EVT at the Department of Neurology,Strategic Support Force Medical Center were retrospectively enrolled.All patients were≥18 years old.Patients were divided into two groups according to their age:the elderly group(age≥80 years)and the younger group(age<80 years).Detailed baseline data(gender,age,past medical historyhypertension,diabetes,hyperlipidemia,atrial fibrillation,severe cardiopulmonary disease et al],baseline of the National Institutes of Health Stroke scaleNIHSS]score,modified Rankin scalemRS]score,the Alberta stroke program early CT scoreASPECTS]or posterior circulation Alberta stroke program early CT scorepc-ASPECTS],the trial of Org 10172 in acute stroke treatmentTOAST]classification et al),the treatment-related information(intravenous thrombolysis,site of occlusion,tandem lesion,time from onset to hospital arrival,time from hospital arrival to puncture,time from puncture to recanalization,anesthesia type,collateral status,balloon dilation or stent implantation,number of passes,modified thrombolysis in cerebral infarctionmTICI]score,symptomatic intracranial hemorrhage et al)and prognosis information of patients 3 months after EVT(mRS score 0-2 indicates good prognosis,mRS score above 3 indicates poor prognosis,and mRS score 6 indicates death)were collected in detail.Results A total of 151 eligible patients with a median age of 70.0(57.5,80.0)years old were enrolled in this study,including 94 males(62.3%).There were 42 patients in the elderly group(27.8%;median age 8381,86]years old)and 109 patients in the younger group(median age 6354,72]years old).The elderly patients had a higher baseline NIHSS scores than younger patients(19.014.3,23.0]vs.15.012.0,20.0],Z=-2.247,P=0.025).Elderly patients were more likely to have atrial fibrillation(81.0%34/42]vs.33.9%37/109],χ²=26.893,P<0.01)and severe cardiopulmonary disease(50.0%21/42]vs.31.2%34/109],χ²=4.631,P=0.031).There was statistically significant difference in TOAST classification distribution between the two groups(χ²=20.193,P<0.01).Cardiogenic embolism(45.9%50/109])and large atherosclerotic thrombosis(44.0%48/109])were the main causes of the stroke in the younger group,and the proportion of cardiogenic embolism was particularly prominent in the elderly group(85.7%36/42]).The younger group had a higher percentage of tandem lesions(22.9%25/109]vs.4.8%2/42],χ²=6.820,P=0.009)and a higher percentage of balloon dilation or stent implantation during surgery than the elderly(32.1%35/109]vs.9.5%4/42],χ²=8.073,P=0.004).The puncture to recanalization time was longer in the elderly group than in the younger group(81.046.0,131.0]min vs.54.536.8,95.0]min,Z=-2.505,P=0.012),and the number of thrombectomy times was also higher in the elderly group(3.01.0,4.0]vs.2.01.0,3.0],Z=-2.225,P=0.026).There were no statistically significant differences in the proportion of successful recanalization(88.1%37/42]vs.84.4%92/109])and NIHSS scores within 24 h after EVT(12.07.0,19.5]scores vs.8.04.0,16.0]scores)between the elderly and younger groups(both P>0.05).The rate of symptomatic intracranial hemorrhage(19.0%8/42]vs.10.1%11/109]),median 90 d mRS(3.02.0,5.0]vs.3.01.0,4.0]),90 d mRS 0-2(31.0%13/42]vs.47.7%52/109]),and 90 d mortality(16.7%7/42]vs.15.6%17/109])were not significantly different between the elderly and younger groups(all P>0.05).Conclusion There is no difference in the prognosis of thrombectomy between the elderly(age≥80 years)and the younger group(age<80 years)in patients with ALVOS.