Endovascular Thrombectomy In The Treatment Of Hyperacute Ischemic Stroke With Large Vessel Occlusion In Elderly Patients

Objective:Recently,A number of foreign experiments have proved that intravenous thrombolytic bridging mechanical thrombectomy using modern devices and techniques has led to improved clinical outcomes following acute ischemic stroke with large vessel occlusion.This article aims to evaluate the safety and efficiency of intravenous thrombolytic bridging mechanical thrombectomy in the treatment of acute ischemic stroke with large vessel occlusion in elderly patients over the age of 65 years and older.Methods: We included 42 patients,using mechanical thrombectomy or intravenous thrombolytic bridging mechanical thrombectomy in the treatment of acute ischemic stroke,from October 2015 to December 2017 at neurology emergency of The Second Hospital of Dalian medical University.All of these patients were confirmed by digital subtraction angiography(DSA)as acute ischemic stroke with large vessel occlusion.Clinical data of these 42 patients was reviewed retrospectively.Patients were divided into those<65 years(n = 17)and those ≥65 years(n = 25)according to age.According to whether the rt-PA was given intravenously before stent thrombectomy,the patients were divided into simple stent thrombectomy group(n = 10)and bridging group(n = 32).Nerve function impairment was assessed using the National Institutes of Health stroke scale(NIHSS),the modified Rankin Scale(mRS)was evaluated for prognosis,and the cerebral infarction thrombolysis grade(TICI)Pass situation.The rate of recanalization,the NIHSS score before surgery,at 24h、14d and 90 d after surgery,the mRS score at 90 d and the complications such as symptomatic intracranial hemorrhage and thrombosis shift were recorded respectively.Results:1.Thirty-four(80.95%)of the 42 patients achieved revascularization(TICI 2b-3),of which 10(23.81%)were completely recanalized(TICI 3).NIHSS scores at 24 h,14d and 90 d after operation were lower than those before operation,and the difference was statistically significant(P<0.05).The number of patients with 90-day mRS scores of 0-2 was 28(66.67%).11(26.19%)patients of intracranial hemorrhage occurred,of which 5(11.90%)cases of symptomatic intracranial hemorrhage,the final death occurred in hernia.6 patients of non-symptomatic intracranial hemorrhage,after medical treatment of hematoma absorption.2.The average age of the older group was 74.22±6.80 years and the recanalization rate was 76.00%.The mean age of the younger group was 56.92±6.78 years and the recanalization rate was 88.24%,with no significant difference(P>0.05).The NIHSS scores at 24 h,14d and 90 d after thrombectomy were lower than those before operation,there was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups on 90 d mRS score 0-2 Statistical significance(64.00% VS 70.59%,P = 0.425),there was no significant difference in the rate of intracranial hemorrhage between the two groups.3.The vascular recanalization was found in 7(70%)patients in the simple thrombectomy group and in 27(84.38%)in the bridging group.There was no significant difference between the two groups(P>0.05).The NIHSS scores at 24 h,14d and 90 d after operation and the mRS score 0-2 at 90 d were not statistically different between the two groups(P>0.05).There was no significant difference in intracranial hemorrhage between two groups.Conclusions: In the treatment of acute ischemic stroke using mechanical thrombectomy or intravenous thrombolytic bridging mechanical thrombectomy both can quickly achieve recanalization.Although older groups have poorer clinical outcomes and more complications than younger patients,intravenous thrombolytic bridging is still relatively safe and effective in elderly patients with acute ischemic stroke.