| BackgroundCerebral apoplexy is one of the three major causes of death and disability worldwide.With the development of aging population,the number of elderly patients with cerebral apoplexy is increasing,and about 1/3 of patients occur in the population over 80 years old.The clinical prognosis of ischemic stroke caused by large vessel occlusion is very poor.Some studies have clearly pointed out that mechanical thrombectomy has a better effect on patients with acute great vessel occlusion of cerebral anterior circulation,but the subjects of the above experiments are mostly non-elderly patients.Currently,there is limited research data on whether elderly patients with anterior cerebral circulation occlusion can benefit from the homogenization of mechanical thrombectomy.ObjectiveTo compare the effectiveness and safety of mechanical thrombectomy in the treatment of acute great vessel occlusion of anterior cerebral circulation in elderly and non-elderly patients,and to provide an objective clinical basis for mechanical thrombectomy in the treatment of elderly patients with acute great vessel occlusion of anterior cerebral circulation,so as to benefit more elderly patients.MethodsA retrospective analysis was performed on 53 cases of patients with acute large vessel occlusion of anterior cerebral circulation treated by mechanical thrombolysis beyond the time window of intravenous thrombolysis in Nanyang central hospital from June 2016 to June 2018.According to the age,the patients were divided into advanced age group(80 years old,n=21)and non-advanced age group(<80 years old,n=32).The key time points in the treatment process of the two groups of patients and the times of thrombus extraction were calculated and compared.The key time points included the time from the onset to the admission,the time from the admission to the puncture,and the time from the puncture to the recanalization.The successful vessel recanalization rate,the change of admission and discharge NIHSS score,the 90-day mRS score and the rate of ineffective recanalization were calculated and compared between the two groups to evaluate the effectiveness of the treatment.The rates of symptomatic intracranial hemorrhage,the rate of pseudoaneurysm,the rate of pulmonary infection,and mortality at 90 days were calculated and compared between the two groups to evaluate the safety of treatment.Results1.Comparison of key time points and times of thrombolysis in the treatment process: The time from onset to admission(304.29±25.99 min VS 300.94±24.14 min,P=0.544),the time from admission to puncture(58.71±22.57 min VS 68.91±28.36 min,P=0.127),the time from puncture to recanalization(74.23±35.21 min VS 76.09± 36.25 min,P=0.851),and the times of thrombus extraction(2.10±0.77 times VS 1.81±0.86 times,P=0.172)in both the elderly and non-elderly groups,the difference was not statistically significant.2.Evaluation of treatment effect: The successful vessel recanalization rate(90.48% VS 93.75%,P=0.659),the change of admission and discharge NIHSS score(7.86±2.31 VS 9.06±2.41,P=0.830),the favorable prognosis rates at 90 days(33.33% VS 43.75%,P=0.448),and the ineffective recanalization rate(57.14% VS 50.0%,P=0.610)of the patients in the elderly group and the non-elderly group were not statistically significant.3.Safety evaluation: No statistically significant difference of incidence of symptomatic intracranial hemorrhage(9.52% VS 9.38%,P=0.986),pseudoaneurysm incidence rate(9.5% vs 0.0%,P=0.075),or 90-day fatality rate(28.57% VS 28.13%,P=0.972)were found between the elderly group and the non-elderly group.The incidence of pulmonary infection between the elderly group and the non-elderly group(52.4% vs.21.9%,P=0.022)was statistically significant.Conclusion1.Mechanical thrombectomy has no difference in the degree of improvement of nerve function defect and the good prognosis rate of 90 days between the elderly and non-elderly patients with acute great vessel occlusion of anterior cerebral circulation.Mechanical thrombectomy is effective for the elderly patients.2.Mechanical thrombectomy does not increase the rate of symptomatic intracranial hemorrhage and mortality for 90 days in elderly patients with acute great vessel occlusion of anterior cerebral circulation,which has a good safety. |
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