Abstract W MP7: Good Outcomes After Endovascular Therapy For Ischemic Stroke In Octogenarians Are Consistently Present If Final Infarct Volume Is Less Than 20 Cubic Centimeters

Abstract

Background and Purpose: Octogenarians are thought to have uniformly poor outcomes following endovascular therapy for stroke. We sought to verify whether this contention hold true when low final infarct volumes (FIV) are achieved following endovascular reperfusion. Methods: Retrospective analysis of an acute stroke endovascular database. Inclusion criteria: age ≥ 80, anterior circulation large vessel occlusion stroke, available outcomes and post procedural MRI allowing for FIV analysis. Results: A total of 1298 patients were identified of which 192 (15%) were octogenarians. Of those 95 with available brain MRI and follow up data were included. Baseline: Median age: 83, female: 67%, median admission NIHSS: 16.4, and median time to treatment: 4.7 hours. Occlusion location: M1 in 71 (73%), M2 in 7 (7%), ICA terminus in 17 (17%), and tandem occlusions in 9 (8.8%) of cases. Atrial fibrillation was found in 57% of cases. Median ASPECTS: 9. Successful recanalization rate (TICI 2b, 3) was achieved in 74%, with a favorable outcome (mRS 0-2) in 23 patients (24%). Median FIV was 38.4 cc (mean 72.2 cc). In patients with favorable outcome, median FIV was 15 cc (interquartile range- IQR 2.4 to 24.5 cc), versus 55.8 cc (IQR 21.1 to 120.5 cc), p=0.0007 in patients with poor outcomes. In 31 patients (32.5%), the FIV was < 20 cc, and of those patients 14 (45%) had a favorable outcome, while only 9 (14%) of patients with FIV > 20 cc achieved favorable outcome, p=0.001. Mean ASPECTS in patients with FIV of < 20 cc was 9.23, versus 8.38 with FIV > 20 cc, p=0.0013. In multivariate analysis, predictors of good outcome included FIV of < 20 cc (odds ratio (OR) 6.6, 95% CI 1.4-27.1), successful recanalization (OR 15.9, 95% CI 1.4 to 1.9), but not age, admission NIHSS, time to treatment or occlusion location. Conclusions: Final infarct volumes of < 20 cc after endovascular acute stroke intervention in octogenarians are associated nearly half of the times with good outcomes while larger final infarcts rarely result in good outcomes. Different baseline infarct thresholds may be necessary when selecting octogenarians vs younger stroke patients for endovascular therapy.