ORIGINAL ARTICLE - VASCULAR
Efficacy, safety, and clinical outcome of modern mechanical
thrombectomy in elderly patients with acute ischemic stroke
Yang-H a Hwang
Received: 27 April 2017 /Accepted: 5 July 2017 / Published online: 20 July 2017
Springer-Verlag GmbH Austria 2017
Background The average life expectancy is increasing world-
wide, surpassing 80 years in some countries. Recently, me-
chanical thrombectomy (MT) using modern devices and tech-
niques has led to improved clinical outcomes following acute
ischemic stroke. However, thus far, it remains uncertain
whether MT is effective in elderly patients aged over 80 years.
Methods Between July 2013 and June 2016, 207 patients with
acute ischemic stroke in the anterior circulation received MT
at our center. The applied MT strategies were forced arterial
suction thrombectomy (FAST) and stent retriever
thrombectomy. Patients were divided into those <80 years
(n = 173) and those ≥80 years (n =34).Wecomparedclinical
and angiographic parameters between groups.
Results The median age was 67.5 in the younger group and 82
in the elderly group; 92.5% of the younger group and 70.6%
of the elderly group received MT via the FAST technique.
Angiographic outcomes, including procedural time, mTICI
2b-3 reperfusion (85.5% vs. 82.4%, p = 0.633), and symptom-
atic intracranial hemorrhage, were not different between the
groups. A favorable clinical outcome rate was significantly
higher in the younger group (62.4% vs. 44.1%, p =0.047).
Younger age, a low NIHSS score, and fast onset to reperfusion
time were favorable prognostic factors in elderly patients.
Conclusion Modern MT in elderly patients with acute ische-
mic stroke is safe and effective compared to younger patients
despite a lower favorable clinical outcome. Our findings may
suggest that an appropriate MT strategy with respect to the
location of the target occlusion and vascular tortuosity might
be helpful to achieve fast reperfusion and improved outcomes
for elderly patients.
Keywords Acute ischemic stroke
Life expectancy continues to increase worldwide, and in some
developed countries, it has exceeded 80 years, a 10-year in-
crease since 1970 . According to OECD data, stroke and
other cerebrovascular diseases accounted for about 7% of all
deaths in OECD countries in 2013, with the majority of that
subset involving ischemic stroke (about 85%) . Although
the mortality rate of cerebrovascular disease has significantly
decreased in recent years as diagnostic and treatment tech-
niques have improved, the absolute number of patients is in-
creasing . Still, it is an important cause of mortality in most
countries, and the disability burden from stroke can be sub-
stantial. Thus, it is easy to predict that ischemic stroke could
become one of the most important health issues in the near
future for most countries.
Electronic supplementary material The online version of this article
(doi:10.1007/s00701-017-3269-y) contains supplementary material,
which is available to authorized users.
* Yong-Won Kim
Department of Neurology, Jinju Hanil Hospital, Jinju, Republic of
Department of Neurosurgery, Kyungpook National University
Hospital, Daegu, Republic of Korea
Department of Radiology, Kyungpook National University Hospital,
Daegu, Republic of Korea
School of Medicine, Kyungpook National University, Daegu, 130,
Dongduk-ro, Jung-gu, Daegu 41944, Republic of Korea
Department of Neurology, Kyungpook National University Hospital,
Daegu, Republic of Korea
Acta Neurochir (2017) 159:1663–1669