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Janssen H, Nannoni S, Francois O, Dewaele T, De Blauwe S, Vanhooren G, Ghekiere J, Kager J, Peeters A, Goffette P, Hammer F, Duprez T, Demeestere J, Lemmens R, Cornelissen S, Heye S, Yperzeele L, Baar I, Voormolen M, Van der Zijden T, Mondelaers A, Andersson T, Pottel H, Odier C, Karkri F, Michel P, Vanacker P. Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians. J Stroke Cerebrovasc Dis 2020; 29:104817. [PMID: 32689620 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/04/2020] [Accepted: 03/14/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly. METHODS Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality. RESULTS Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days. CONCLUSIONS Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.
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Affiliation(s)
- Helena Janssen
- Ghent University, Department of neurology, Gent, Belgium.
| | | | | | | | | | | | | | | | - André Peeters
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | - Frank Hammer
- Cliniques Universitaires Saint-Luc, Brussel, Belgium
| | | | | | | | | | - Sam Heye
- University Hospital Leuven, Leuven, Belgium
| | | | - Ingrid Baar
- Antwerp University Hospital, Edegem, Belgium
| | | | | | | | - Tommy Andersson
- Ghent University, Department of neurology, Gent, Belgium; AZ Groeninge Kortrijk and Karolinska Sweden
| | - Hans Pottel
- University of Leuven campus Kortrijk, Kortrijk, Belgium
| | - Céline Odier
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Fatine Karkri
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Patrik Michel
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Antwerp University Hospital, Edegem, Belgium; AZ Groeninge Kortrijk, Antwerp University Hospital and University Antwerp, Antwerpen, Belgium
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Iratni R, Karkri F, Deslandres C, Jantchou P. A219
TRENDS IN TNF-ALPHA INHIBITOR UTILIZATION IN CHILDREN WITH IBD DURING THE LAST 10 YEARS: 2009–2018. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Iratni
- University of Montreal, Montreal, QC, Canada
| | - F Karkri
- University of Montreal, Montreal, QC, Canada
| | - C Deslandres
- CHU Sainte-Justine, Department of Pediatrics, Unit of Gastroenterology, Montreal, QC, Canada
| | - P Jantchou
- CHU Sainte-Justine, Department of Pediatrics, Unit of Gastroenterology, Montreal, QC, Canada
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Beaulieu MC, Karkri F, Poppe AY, Gioia L, Deschaintre Y, Jacquin G, Daneault N, Stapf C, Odier C. Abstract WMP9: Real-World Outcomes of Patients Presenting with Acute Ischemic Stroke >6 Hours Since Symptom Onset Treated With Endovascular Therapy. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Endovascular therapy(EVT) is proven effective for patients with acute ischemic stroke with proximal vessel occlusion, treated within 6 hours since symptom onset. However, up to 30% of stroke patients wake up with their symptoms (“wake-up stroke” (WUS)) or have an unknown time of onset. Canadian guidelines suggest that EVT may also be effective up to 12 hours after onset and yet-to-be published data from the DAWN trial also suggest a strong benefit of EVT for these patients if selected by perfusion imaging. We aimed to examine the real-world effectiveness of EVT in late-presenting stroke patients selected for EVT with a simple non-contrast CT (NCCT) and simple phase CT angiogram (CTA).
Methods:
We analyzed a prospectively collected registry of epidemiological, clinical and imaging data of patients treated for acute ischemic stroke ≥6 hours since symptom onset or WUS in a tertiary stroke center (Hôpital Notre-Dame, Montréal) between 2016 and 2017. Eligibility for EVT was based on a combination of disabling neurological deficit, a NCCT with salvageable brain tissue (ASPECTS >5), and presence of a LVO on CTA.
Results:
Over a 16-month period, a total of 366 patients were treated with IV thrombolysis and/or EVT. Of these, 46 had WUS or presented ≥ 6 hours since symptom onset and received EVT. Median age was 70, median baseline mRS score 1, median NIHSS at arrival 17 and median ASPECTS 9. Good collaterals on CTA were noted in 63%(29) of patients. 5 patients had posterior circulation stroke with basilar occlusion. Median time from last time seen normal to admission was 9h17(IQR, 6h44-12h46). 31 (67.4%) NCCTs were done at a referent center and not repeated locally to avoid treatment delays. At 3-month follow-up, functional autonomy(mRS
≤
2) was found in 15 (32.6%) patients while 15 (32,6%) died (mRS=6). Symptomatic hemorrhagic transformation occurred in 3(6.5%) patients.
Conclusions:
In a real-world setting, EVT is feasible in late-presenting stroke patients selected by NCCT and yields favorable outcomes similar to those seen in the more pragmatic EVT trials.
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