Effects of clinical outcomes by modification of patient selection protocol based on premorbid independence for mechanical thrombectomy in older adult patients

Kota Kurisu; Juro Sakurai; Hajime Wada; Seiji Takebayashi; Tohru Kobayashi; Katsumi Takizawa

doi:10.4103/bc.bc_73_21

Effects of clinical outcomes by modification of patient selection protocol based on premorbid independence for mechanical thrombectomy in older adult patients

Brain Circ. 2022 Mar 21;8(1):24-30. doi: 10.4103/bc.bc_73_21. eCollection 2022 Jan-Mar.

Authors

Kota Kurisu¹, Juro Sakurai¹, Hajime Wada¹, Seiji Takebayashi¹, Tohru Kobayashi¹, Katsumi Takizawa¹

Affiliation

¹ Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Hokkaido, Japan.

Abstract

Objectives: Since the beneficial effect attained by mechanical thrombectomy (MT) seems to be worse in older than in the younger population, the establishment of an ideal and distinctive patient selection protocol in older is warranted. Herein, we modified our patient selection protocol based on age and premorbid independence in older adult patients.

Materials and methods: We retrospectively reviewed 141 consecutive patients with acute ischemic stroke who were treated with MT between 2015 and 2020. We started to restrict the indication of MT in very old patients (≥85-year-old) with severe premorbid functional independence (≥modified Rankin Scale [mRS] 3) in 2018. Clinical outcomes before the modification of protocol (period 1) were compared to after (period 2).

Results: Although there were no significant differences in median mRS at 90 days and the rates of favorable outcomes (mRS 0-2) between both periods, rates of poor outcomes (mRS 5, 6) significantly decreased (37.3% vs. 19.7%, P = 0.021) during period 2 compared with period 1. For older adults (≥80-year-old), median mRS was significantly better (P = 0.012) during period 2 than period 1. During period 1, rates of favorable outcomes were significantly lower (P = 0.004) in older than in younger. However, this significant difference was diminished (P = 0.28) during period 2.

Conclusion: Our modified patient selection protocol in older adults, not only limited by age but also premorbid function, improved the therapeutic outcome of MT. In rapidly aging society, further investigations facilitating a better understanding are necessary to establish an optimal patient selection protocol.

Keywords: Acute ischemic stroke; elderly; endovascular treatment; mechanical thrombectomy.