TY - JOUR
T1 - Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry
AU - Groot, Adrien E.
AU - Treurniet, Kilian M.
AU - Jansen, Ivo G. H.
AU - Lingsma, Hester F.
AU - Hinsenveld, Wouter
AU - van de Graaf, Rob A.
AU - Roozenbeek, Bob
AU - Willems, Hanna C.
AU - Schonewille, Wouter J.
AU - Marquering, Henk A.
AU - van den Berg, Rene
AU - Dippel, Diederik W. J.
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - Coutinho, Jonathan M.
AU - van Zwam, Wim
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
A.E. Groot, K.M. Treurniet, I.G.H. Jansen, H.F. Lingsma, W. Hinsenveld, R.A. van de Graaf, B. Roozenbeek, H.C. Willems, W.J. Schonewille, H.A. Marquering, and R. van den Berg report no disclosures relevant to the manuscript. D.W.J. Dippel reports fees for consultations by Stryker and Bracco Imaging; grants from Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, The Netherlands Organisation for Health Research and Development, and Health Holland Top Sector Life Sciences & Health; and unrestricted grants from AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, Top Medical/Concentric, Stryker, Stryker European Operations BV, Penumbra Inc, Medtronic, Thrombolytic Science, LLC and Cerenovus, all paid to institution. C.B.L.M. Majoie reports the following disclosures: related: grants from the TWIN Foundation; unrelated: grants from the CVON/ Dutch Heart Foundation, Stryker, European Commission, TWIN Foundation, and Health Evaluation Netherlands (all paid to institution); and shareholder of Nico-lab, a company that focuses on the use of artificial intelligence for medical image analysis. Y.B.W.E.M. Roos is minor shareholder of Nico-Lab, a company focusing on a decision support system based on artificial intelligence assessment of stroke imaging. J.M. Coutinho received unrelated research support from the Dutch Heart Foundation, Bayer, Boehringer, and Medtronic. All fees were paid to his employer. Go to Neurology.org/N for full disclosures.
Funding Information:
The MR CLEAN Registry was partly funded by the TWIN Foundation, Erasmus MC University Medical Center, Maas-tricht University Medical Center, and Amsterdam UMC.
Publisher Copyright:
© American Academy of Neurology.
PY - 2020/7/14
Y1 - 2020/7/14
N2 - Objective To explore clinical outcomes in older adults with acute ischemic stroke treated with endovascular thrombectomy (EVT). Methods We included consecutive patients (2014-2016) with an anterior circulation occlusion undergoing EVT from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the effect of age (dichotomized at >= 80 years and as continuous variable) on the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH), and reperfusion rate. The association between age and mRS was assessed with multivariable ordinal logistic regression, and a multiplicative interaction term was added to the model to assess modification of reperfusion by age on outcome. Results Of the 1,526 patients, 380 (25%) were >= 80 years of age (referred to here as older adults). Older adults had a worse functional outcome than younger patients (adjusted common odds ratio [acOR] for an mRS score shift toward better outcome 0.31, 95% confidence interval [CI] 0.24-0.39). Mortality was also higher in older adults (51% vs 22%, adjusted odds ratio 3.12, 95% CI 2.33-4.19). There were no differences in proportion of patients with mRS scores of 4 to 5, sICH, or reperfusion rates. Successful reperfusion was more strongly associated with a shift toward good functional outcome in older adults than in younger patients (acOR 3.22, 95% CI 2.04-5.10 vs 2.00, 95% CI 1.56-2.57,p(interaction)= 0.026). Conclusion Older age is associated with an increased absolute risk of poor clinical outcome, while the relative benefit of successful reperfusion seems to be higher in these patients. These results should be taken into consideration in the selection of older adults for EVT.
AB - Objective To explore clinical outcomes in older adults with acute ischemic stroke treated with endovascular thrombectomy (EVT). Methods We included consecutive patients (2014-2016) with an anterior circulation occlusion undergoing EVT from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the effect of age (dichotomized at >= 80 years and as continuous variable) on the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH), and reperfusion rate. The association between age and mRS was assessed with multivariable ordinal logistic regression, and a multiplicative interaction term was added to the model to assess modification of reperfusion by age on outcome. Results Of the 1,526 patients, 380 (25%) were >= 80 years of age (referred to here as older adults). Older adults had a worse functional outcome than younger patients (adjusted common odds ratio [acOR] for an mRS score shift toward better outcome 0.31, 95% confidence interval [CI] 0.24-0.39). Mortality was also higher in older adults (51% vs 22%, adjusted odds ratio 3.12, 95% CI 2.33-4.19). There were no differences in proportion of patients with mRS scores of 4 to 5, sICH, or reperfusion rates. Successful reperfusion was more strongly associated with a shift toward good functional outcome in older adults than in younger patients (acOR 3.22, 95% CI 2.04-5.10 vs 2.00, 95% CI 1.56-2.57,p(interaction)= 0.026). Conclusion Older age is associated with an increased absolute risk of poor clinical outcome, while the relative benefit of successful reperfusion seems to be higher in these patients. These results should be taken into consideration in the selection of older adults for EVT.
KW - MECHANICAL THROMBECTOMY
KW - THERAPY
KW - OUTCOMES
KW - AGE
U2 - 10.1212/WNL.0000000000009764
DO - 10.1212/WNL.0000000000009764
M3 - Article
C2 - 32527972
SN - 0028-3878
VL - 95
SP - E131-E139
JO - Neurology
JF - Neurology
IS - 2
ER -