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A6880 - Functional Outcomes Post-Thrombectomy In Elderly Stroke Patients
Author Block: L. O'Keefe1, A. Gautam1, R. Bhardwaj1, M. Afshani2, P. Grover3; 1Internal Medicine, University of Connecticut Health Center, Farmington, CT, United States, 2Neurology, St. Francis Hospital, Hartford, CT, United States, 3Pulmonology and Critical Care, St. Francis Hospital, Hartford, CT, United States.
Introduction: Mechanical thrombectomy for proximal occlusions in acute ischemic stroke (AIS) patients has been demonstrated to be superior to intravenous fibrinolysis leading to improved functional outcomes and reduced mortality. However, limited data exists regarding its use in elderly patients (age>80) and whether baseline function affects outcomes post-thrombectomy. We hereby report two elderly stroke patients treated with mechanical thrombectomy with differing functional outcomes.
Case Description: An 84-year-old female with past medical history of atrial fibrillation, hypertension, and coronary artery disease who is independent in all activities of daily living (ADLs) presented with right-sided weakness and garbled speech with an initial National Institutes of Health Stroke Scale (NIHSS) of 20. CT head showed no acute intracranial hemorrhage, and CT angiogram demonstrated a left M1 occlusion of the left middle cerebral artery (MCA). She was not a candidate for intravenous (IV) thrombolytics (tPA) secondary to unknown time of symptom onset, and subsequently underwent mechanical thrombectomy with complete resolution of her symptoms and a discharge NIHSS of 0.
In contrast, a 96-year-old female with similar vascular risk factors as the above patient presented from a nursing facility with acute right-sided weakness, expressive aphasia and initial NIHSS of 13. At baseline, she uses a walker and requires assistance with ADLs. CT head was negative, and CT angiogram demonstrated an occluded M2 branch of the left MCA. The patient was out-of-window for IV tPA and underwent mechanical thrombectomy. Post-procedure, her motor symptoms improved, however she continued to have expressive aphasia and was discharged to a short term rehabilitation facility with an NIHSS 11.
Discussion: Mechanical thrombectomy is recommended as the standard of care in AIS patients with proximal occlusions, but there is limited data in patients older than 80 despite this age group constituting one third of all strokes. Recent data showed favorable outcomes post-thrombectomy in patients aged >80, however all patients were independent in ADLs at baseline. Our patients had variable outcomes, which may have been impacted by their original functional status. This highlights the need for large scale studies to determine the eligibility and efficacy of mechanical thrombectomy in the elderly, as more of the general population are approaching this age. Further, we need to identify if this is a viable treatment option for this population in the context of their functional status and overall quality of life, as this may be a preferable treatment over IV tPA due to lower risks of bleeding.