Supplementary Material for: Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability

<b><i>Background:</i></b> The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. <b><i>Methods:</i></b> Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. <b><i>Results:</i></b> Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, <i>p</i> = 0.08), between those aged ≤85 and those aged &gt; 85 years (40.8 vs. 26.1%, <i>p</i> = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, <i>p</i> = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (<i>p</i> &lt; 0.001 and <i>p</i> = 0.009, respectively). <b><i>Conclusion:</i></b> Advanced age, baseline disability, and delayed treatment are associated with sub­optimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment.

<b><i>背景：</i></b> 缺血性脑卒中老年患者的数量正逐年攀升。机械取栓（mechanical thrombectomy, MT）的随机对照试验通常会排除基线存在功能残疾的80岁以上患者。本研究旨在探究机械取栓在老年脑卒中患者中的疗效与安全性，此类患者中多数可能存在基线功能损害。<b><i>方法：</i></b> 2015年1月至2017年4月期间，本研究纳入96例年龄≥80岁、因缺血性脑卒中接受机械取栓治疗的患者，对其病历资料进行回顾性分析。收集的数据包括患者基线特征、至治疗的时间间隔、血管再通率、手术相关并发症、死亡率，以及以改良Rankin量表（modified Rankin Scale, mRS）评分0~2分或恢复至基线功能水平定义的90天良好预后结局。<b><i>结果：</i></b> 96例患者中，50例基线存在轻度残疾（mRS评分0~1分），46例存在中度残疾（mRS评分2~4分）。84%的患者实现成功血管再通，症状性出血发生率为6%。随访至90天时，34%的患者获得良好预后。基线轻度残疾与中度残疾患者的良好预后率无显著统计学差异（43% vs. 24%，<i>p</i> = 0.08）；年龄≤85岁与>85岁患者的良好预后率亦无显著差异（40.8% vs. 26.1%，<i>p</i> = 0.19）；发病后8小时内接受治疗与超过8小时接受治疗的患者，其良好预后率同样无显著差异（39% vs. 20%，<i>p</i> = 0.1）。90天总体死亡率为38.5%。阿尔伯塔卒中项目早期CT评分（Alberta Stroke Program Early CT Score, ASPECTS）与美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）均可独立预测患者的良好预后，且该预测价值不受基线残疾状态影响（分别为<i>p</i> < 0.001及<i>p</i> = 0.009）。<b><i>结论：</i></b> 高龄、基线功能残疾及治疗延迟均与机械取栓术后的次优预后相关。然而，若将良好预后重新定义为包括恢复至基线功能水平，则可见该患者群体中有三分之一可从机械取栓治疗中获益，这提示该疗法在真实临床场景中的实际应用价值。