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Chronic Infarcts Predict Poor Clinical Outcome in Mechanical Thrombectomy of Sexagenarian and Older Patients
Niko Sillanpää1, Juha-Pekka Pienimäki1, Sara Protto1
1Medical Imaging Center, Tampere University Hospital, Tampere, Finland.
Insights
Chronic ischemic lesions impact outcomes for older stroke patients undergoing mechanical thrombectomy. The absence of these lesions significantly improves the chances of a good clinical outcome after the procedure.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- The impact of chronic ischemic lesions on mechanical thrombectomy (MT) outcomes is understudied.
- Older patients generally benefit from MT for acute stroke.
- This study focuses on sexagenarian and older patients with acute middle cerebral artery (MCA) or distal internal carotid artery (ICA) large-vessel occlusion (LVO) receiving MT.
Purpose of the Study:
- To investigate the effect of chronic ischemic lesions (CILs) on the clinical outcome of MT in older adult stroke patients.
- To determine if the presence or absence of CILs influences functional recovery after MT for MCA or distal ICA LVO.
Main Methods:
- Prospective collection of clinical and imaging data from 130 MT patients; analysis focused on 68 sexagenarian and older patients with M2 segment or proximal occlusions.
- Collected baseline clinical, procedural, and imaging variables, technical and 24-hour imaging outcomes, and 3-month clinical outcomes.
- Statistical tests and binary logistic regression were used to compare outcomes between patients with and without CILs.
Main Results:
- Twenty-one patients (31%) had at least one CIL.
- Patients with CILs had a lower rate of good clinical outcome (38%) compared to those without (62%), though this trend was not statistically significant (P=0.06).
- Absence of CILs was associated with a 3.7-fold increased odds of good clinical outcome (P=0.05) in logistic regression.
Conclusions:
- Chronic cortical and lacunar infarcts identified on admission imaging are linked to poorer clinical outcomes in older patients undergoing MT for MCA or distal ICA LVO.
- The presence of CILs may negatively affect functional recovery after MT in this patient population.
- Further research is warranted to elucidate the precise role of CILs in MT outcomes for elderly stroke patients.
Background:
The impact of lacunar and cortical chronic ischemic lesions (CILs) on the clinical outcome of mechanical thrombectomy (MT) has been little studied. Clinical trials suggest that older patients benefit from MT. We investigated the effect of CILs on the clinical outcome of sexagenarian and older patients with acute middle cerebral artery (MCA) or distal internal carotid artery (ICA) stroke who received MT to treat large-vessel occlusion (LVO).
Methods:
We prospectively collected the clinical and imaging data of 130 consecutive MT patients of which 68 met the inclusion criteria. We limited the analysis to sexagenarian and older subjects and occlusions no distal than the M2 segment. Baseline clinical, procedural and imaging variables, technical outcome, 24-hour imaging outcome, and the clinical outcome were recorded. Differences between patients with and without CILs were studied with appropriate statistical tests and binary logistic regression analysis.
Results:
Twenty-one patients (31%) had at least 1 CIL. Thirty-eight percent of patients with CIL(s) compared with 62% without (P = .06) experienced good clinical outcome (3-month modified Rankin Scale ≤ 2). A similar nonsignificant trend was seen when lacunar lesions, lesion multiplicity, and chronic white matter lesions were examined separately. Absence of CIL increased the odds of good clinical outcome 3.7-fold (95% confidence interval 1.0-10.7, P = .05) in logistic regression modeling.
Conclusions:
Chronic cortical and lacunar infarcts in admission imaging are associated with poor clinical outcome in sexagenarian and older patients treated with MT for LVO of the MCA or distal ICA.
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