Introduction: Recent publication of results from MR Clean, ESCAPE, and EXTEND-IA have dramatically altered the treatment of acute ischemic stroke by demonstrating the efficacy of mechanical thrombectomy over intravenous alteplase. EXTEND-IA was stopped early due to overwhelming efficacy of thrombectomy group compared to control by using physiologic imaging study for patient selection. The very elderly (age > 80) was only barely included in the EXTEND-IA trial (age up to 81 for the interventional group). We present a series of 13 patients (age 80 – 97) whom received mechanical thrombectomies for acute ischemic stroke and their outcomes.
Methods: We retrospectively reviewed all mechanical thrombectomies presented at our institution from January 2012 to June 2014 and identified 18 patients whom received endovascular intervention for stroke. The CT perfusion findings, vessel occluded, TICI revascularization score, 3-month mRS were recorded and analyzed.
Results: Of these, 14 had physiologic imaging in the form of CT perfusion pre-operatively. 8 of these 14 patients had mostly penumbra on CT Perfusion study, while 6 patients had moderate penumbra and some core infarct pre-op. Good outcome (mRS = 2) was achieved in 5 patients, and 4 of those received pre-operative physiologic imaging studies (80% had physiologic imaging study among all patients with good outcomes, and 28.5% of all thrombectomy candidates based on CT Perfusion). Among patients whom showed mostly penumbra on CT Perfusion, 37.5% had good outcome after thrombectomy.
Conclusions: Physiologic imaging studies in the form of CT Perfusion, although can be subjective, does play a role in selecting appropriate candidates for thrombectomies in the very elderly patient.
Patient Care: This research fills in the gap between available latest data from multiple trials and the real life examples of facing the challenge of treating the very elderly with limited data.
Learning Objectives: Being Very Elderly should not be excluded from mechanical thrombectomy, Physiologic imaging may play an effective role in providing a basis for patient selection.