Efficacy and safety of endovascular thrombectomy for ischemic stroke in elderly patients

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Resumo

Endovascular thrombectomy is an effective and safe method for the treatment of ischemic stroke, but this method is poorly studied in elderly patients.

A clinical case of successful endovascular thrombectomy in a patient aged 90 years with ischemic stroke and middle cerebral artery occlusion is presented.

Sobre autores

A. Sapanyuk

Ministry of Health of the Moscow Region

Autor responsável pela correspondência
Email: erho@bk.ru

Candidate of Medical Sciences

Rússia, Krasnogorsk

Yu. Raikhman

Voskresensk Hospital

Email: erho@bk.ru
Rússia, Moscow Region

M. Kuznetsov

Voskresensk Hospital

Email: erho@bk.ru
ORCID ID: 0009-0004-5184-0517
Rússia, Moscow Region

M. Glezer

Ministry of Health of the Moscow Region; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Moscow Regional Research and Clinical Institute ("MONIKI")

Email: erho@bk.ru
ORCID ID: 0000-0002-0995-1924

Professor, MD

Rússia, Krasnogorsk; Moscow; Moscow

A. Azarov

Ministry of Health of the Moscow Region; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Moscow Regional Research and Clinical Institute ("MONIKI")

Email: erho@bk.ru
ORCID ID: 0000-0001-7061-337X

Candidate of Medical Sciences

Rússia, Krasnogorsk; Moscow; Moscow

M. Sutormin

Ministry of Health of the Moscow Region; Moscow Regional Research and Clinical Institute ("MONIKI")

Email: erho@bk.ru
Rússia, Krasnogorsk; Moscow

G. Ayvazyan

Voskresensk Hospital

Email: erho@bk.ru
ORCID ID: 0000-0002-3968-6180
Rússia, Moscow Region

T. Kuropii

Voskresensk Hospital

Email: erho@bk.ru
ORCID ID: 0000-0001-6916-4845
Rússia, Moscow Region

Bibliografia

  1. Benjamin E.J., Blaha M.J., Chiuve S.E. et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association [published correction appears in Circulation. 2017; 135 (10): e646] [published correction appears in Circulation. 2017; 136 (10): e196]. Circulation. 2017; 135 (10): e146-e603. doi: 10.1161/CIR.0000000000000485
  2. Goyal M., Menon B.K., van Zwam W.H. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387 (10029): 1723–31. doi: 10.1016/S0140-6736(16)00163-X
  3. Albers G.W., Marks M.P., Kemp S. et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018; 378 (8): 708–18. doi: 10.1056/NEJMoa1713973
  4. Nogueira R.G., Jadhav A.P., Haussen D.C. et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018; 378 (1): 11–21. doi: 10.1056/NEJMoa1706442
  5. Marini C., Baldassarre M., Russo T. et al. Burden of first-ever ischemic stroke in the oldest old: evidence from a population-based study. Neurology. 2004; 62: 77–81. doi: 10.1212/01.wnl.0000101461.61501.65
  6. Mehta A., Fifi J.T., Shoirah H. et al. National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly. J Stroke Cerebrovasc Dis. 2021; 30 (2): 105505. doi: 10.1016/j.jstrokecerebrovasdis.2020.105505
  7. Turk A.S., Frei D., Fiorella D. et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg. 2018; 10 (Suppl 1): i4-i7. doi: 10.1136/neurintsurg-2014-011125.rep
  8. Hilditch C.A., Nicholson P., Murad M.H. et al. Endovascular Management of Acute Stroke in the Elderly: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2018; 39 (5): 887–91. doi: 10.3174/ajnr.A5598
  9. Zhao W., Ma P., Zhang P. et al. Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarians: A Systematic Review and Meta-Analysis. Front Neurol. 2020; 10: 1355. doi: 10.3389/fneur.2019.01355
  10. Jovin T.G., Chamorro A., Cobo E. et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372 (24): 2296–306. doi: 10.1056/NEJMoa1503780
  11. Fujita K., Tanaka K., Yamagami H. et al. Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years [published correction appears in Stroke. 2021; 52 (8): e524]. Stroke. 2021; 52 (5): 1561–9. doi: 10.1161/STROKEAHA.120.031386

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2. Fig. 1. Occlusion of the left middle cerebral artery at the level of M1-M2 segment: a – CT angiography of cerebral vessels; б – selective angiography of the left common carotid artery

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3. Fig. 2. Endovascular thrombectomy from M1-M2 segments of the left middle cerebral artery: a – mechanical aspiration from the left middle cerebral artery; б – control angiography in the anteroposterior projection; в – control angiography in the lateral projection

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