Abstract WP27: Patient Age and Outcomes of Those Receiving Endovascular Thrombectomy Treatment in San Diego County

Abstract

Background: Endovascular thrombectomy (EVT) after Ischemic Stroke (AIS) has shown to improve outcomes in multiple large clinical trials. While most guidelines lifted the age restriction, few patients enrolled in clinical trials were over 79 years of age. We studied EVT over time in San Diego County as it relates to patient age. We sought to understand age distribution of patients receiving EVT, frequency by which patients 79 and older received treatment, and whether that frequency changed over time. Methods: We included AIS patients with a reported age and NIHSS from 10 EVT capable centers from July 2016 through December 2018 from the San Diego County EMS Stroke Registry. We analyzed frequency of EVT by patient age, last known normal (LKN) to groin puncture time, NIHSS and hospital discharge disposition. Results: Between July 2016 and December 2018, of 7,049 AIS patients, 659 (9.3%) received EVT. The mean (±SD) age of EVT patients was 71.9 (±15.6) years, ranging from 24 to 104 years old. Of these patients, 250 (37.9%) were >79 years. On average (±SD), 22.1 (±4.2) patients received EVT per month. Rate of EVT use among all AIS patients did not change over time (p=.24). On average (±SD) 8.4 (±3.3) patients >79 years underwent EVT per month. Rate of EVT among patients >79 years did not change over time (p=.31). EVT rate among patients ≤ 79 years increased over time (p=.02). EVT patients >79 years had a mean (±SD) initial NIHSS of 19.2 (±8.2) compared to EVT patients ≤ 79 years NIHSS 16.0 (±8.6) (p=.000002). Overall mean (±SD) LKN to groin puncture was 6.2 hours (±7.0), >79 years 5.6 (±5.7), ≤ 79 years 6.5 hours (±7.6) (p=.11). EVT patients >79 years were discharged to a Skilled Nursing Facility (SNF) (32.9%), died in-hospital (19.0%), and transferred to acute care (15.9%); patients ≤ 79 years were discharged to home (35.2%), SNF (17.6%), and Inpatient Rehabilitation Facility (15.7%). Conclusion: Endovascular thrombectomy for patients older than 79 years accounts for nearly one in four patients receiving EVT. The frequency of EVT use in the elderly did not change over time while use in patients under age 80 increased slightly. However, overall use of EVT remained consistent. Older patients receiving EVT had a higher NIHSS and were more commonly discharged to a SNF compared to younger patients.