A Prognostic Scoring System Of Mechanical Thrombectomy For Elderly Patients

Background and Purpose: Japan has a rapidly aging population and the application of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) among elderly patients has increased, but feasibility and safety of MT for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of MT by analyzing the retrospective multicenter database. Methods: A total of 763 consecutive patients who underwent MT for AIS between January 2013 and January 2020 at six comprehensive stroke centers were enrolled in this study. We analyzed elderly AIS patients defined as those aged ≥ 75 years with IC/M1/M2 occlusion. Good outcome was defined mRS 0-2 at 90 days after onset, and we investigated the factors associated with good outcome. Results: A total of 523 patients with IC/M1/M2 occlusion were analyzed, of which 316 were elderly (52%). Good outcome was significantly decreased in elderly AIS patients compared with non-elderly patients (35 % vs 56 %, p=0.0007). Among the elderly AIS patients, aged < 90 years, male sex, NIH stroke scale, prior administration of anticoagulants, mRS before onset, ASPECTS, M2 occlusion, and dyslipidemia were associated with good outcome with multivariable analysis. An elderly AIS prognostic scoring system (eAIS-PSS) was set up based on these factors , and the areas under the curves (AUC) was 0.78 at the optimal cut-off value of 7 / 22 with this scoring system. eAIS-PSS predicted good outcome with a sensitivity of 72% and a specificity of 75%. Conclusion: eAIS-PSS was useful to predict good outcome in MT for elderly AIS patients.