Table 1.
Summary of current published studies designed to assess clinical outcome after very elderly patients with anterior circulation stroke undergo IAT.
| Author (year) | Age used to define elderly cohort | Number of very elderly patients | Number of younger controls | sICH rate in elderly cohort | Primary outcome measures | Summary of primary outcome |
|---|---|---|---|---|---|---|
| Singer et al. (11) | 77 | Registry of 362 patients; 25% of cohort >76; 91 patients | Registry of 362 patients; 75% of cohort 18–76 years; 271 patients | Not reported; 3% ECASS parenchymal hematoma type II in total cohort | 90-day mRS and “futile recanalization” | Outcome is age-dependent with elderly patients (in the highest age quartile of 77–94 years) having the lowest rates of good outcome (mRS 0–2) of 17% compared to 60% for patients in the lowest age quartile (18–56 years). Elderly (77–94 years) patients had higher rates (46 vs. 24%) of clinically “futile recanalization” (defined as 90-day mRS score ≥3 despite successful recanalization and no subsequent hemorrhage) compared the lowest age quartile (18–56 years) |
| Kurre et al. (7) | 80 | 109 | 0 | 6% ECASS parenchymal hematoma type II | 90-day mRS | 13% had pre-stroke disability of mRS score 3–4. By 90 days, 17% of elderly patients had a mRS score 0–2; mortality rate was 48% |
| Willey et al. (15) | 80 | 186 | 622 | Not reported | In-hospital mortality | Very elderly patients had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (IAT and/or IVT) (OR, 2.13; 95% CI, 1.60–2.84). IAT does not increase the risk of in-hospital mortality in very elderly patients compared to IVT alone |
| Chandra et al. (5) | 80 | 49 | 130 | 4% ECASS parenchymal hematoma type II | 90-day mRS and mortality | Very elderly patients had significantly lower rates of good outcome (mRS 0–2: 2 vs. 33%; P < 0.0001) and higher mortality (59 vs. 24%; P < 0.0001) at 90 days compared to younger patients |
| Mono et al. (9) | 80 | 43 | 524 | 2% | 90-day mRS and mortality | Very elderly patients had significantly lower rates of good outcome (mRS 0–2: 28 vs. 46%; P = 0.019) and higher mortality (40 vs. 22%; P = 0.0008) at 90 days compared to younger patients |
| Ghobrial et al. (29) | 75 | 51 patients aged 75 or greater | 0 | 6% | Discharge mRS | At time of discharge, 33% of elderly patients had a mRS score 0–3; mortality rate at discharge was 22% |
| Arkadir et al. (4) | 80 | 14 | 66 | 7% | 90-day mRS | Very elderly patients had significantly lower rates of good outcome (mRS 0–2: 0 vs. 41%; P = 0.008) |
| Mazighi et al. (8) | 80 | 25 | 59 | 12% | 90-day mRS | Very elderly patients had significantly lower rates of good outcome (mRS 0–2: 28 vs. 64%; P = 0.002) and higher mortality (40 vs. 22%; P = 0.002) at 90 days compared to younger patients |
| Loh et al. (30) | 80 | 31 | 75 | 11% | mRS at discharge and stroke-related death | Very elderly patients had lower rates (not statistically significant) of good outcome (mRS 0–2: 19 vs. 33%; P = 0.17) at discharge compared to younger patients. Rates of stroke-related death were significantly higher in elderly patients (48 vs. 15%; P = 0.0005) at discharge compared to younger patients |
| Qureshi et al. (10) | 80 | 24 | 77 | 8% | 30–90 day mRS and mortality | Very elderly patients had lower rates (not statistically significant) of good outcome (mRS 0–2: 21 vs. 38%; P = 0.21) at 30–90 days compared to younger patients. There were higher rates of mortality (54 vs. 29%; P = 0.02) as compared to younger patients |
| Kim et al. (6) | 80 | 33 | 81 | 7% | 90-day mRS | Very elderly patients had significantly lower rates of good outcome (mRS 0–2: 26 vs. 40%; P = 0.02) and higher mortality (43 vs. 20%; P = 0.01) at 90 days compared to younger patients |