Effect Of Elders On Prognosis Of Patients With Acute Ischemic Stroke Treated With Endovascular Treatment

Objective:To investigate the feasibility,safety and effectiveness of endovascular treatment for the elders with acute ischemic stroke,and to analyze the causes of perioperative major complications after endovascular treatment.Material and Methods:From January 2016 to December 2017 in the study included hospital neurology department of No.1 Hospital of Jilin University of the 163 patients with acute ischemic stroke.The patients was received by perfusion CT or DSA examination.And the onset or aggravation(NIHSS score increased by 4points)to the visit was less than 72 hours.Patients older than 70 years were studied as subjects and patients younger than 70 years as control group,including 40 patients in the experimental group and 123 patients in the control group.The basic information,time of onset,puncturing time and other perioperative information were collected.Intravenous thrombolytic therapy can be given in the 4.5 hour window according to the patient's onset time.According to the condition of the vessel in the target lesion,was selected for the operation of mechanical thrombectomy,aspiration,balloon dilatation,and stent implantation.After discharge,the patients were followed up by telephone or ultrasonic examination.According to 90 d m RS score,0-2 points were defined as good prognosis,6 points were death,and blood vessel recanalization was classified according to m TICI blood flow grading.MTICI rating 0-1 level was defined as blood vessel failure and 2b-3 level was good recanalization.Results:The prognosis of elderly patients and non elderly controls was 32.5%(13/40)and 52%(64/123),respectively,with a mortality rate of 17.5%(7/40)and 15.4%(19/123).DSA angiography after operation showed that the good recanalization rate in the elderly group was 85%(34/40),while that in the control group was 82.1%(101/123),and there was no significant difference in the recanalization rate between the two groups.In the elderly patients,5 cases(12.5%)had complications,all of which were symptomatic intracranial hemorrhage,of which 4 cases died after bleeding.In the control group,17 cases(13.8%)had complications,12 cases were symptomatic intracranial hemorrhage,5 cases died after bleeding,2 cases were reocclusion,2 cases had vascular dissection,1 cases of gastrointestinal hemorrhage complicated with cerebral hernia died.There were 14 cases(35%)of elderly patients with combined atrial fibrillation,17 cases(42.5%)had postoperative pulmonary infection,13 cases(31.7%)had postoperative limb vein thrombosis.In control group14 patients(11.4%)had combined with atrial fibrillation,31 cases(25.2%)had postoperative pulmonary infection,20 cases(16.2%)had postoperative limb vein thrombosis.Conclusion:1.Advanced age has no significant effect on vascular recanalization rate in patients with acute ischemic stroke after endovascular treatment.2.The incidence of endovascular therapy in elderly patients with acute ischemic stroke is significantly higher than that of non elderly patients and the perioperative management of elderly patients needs to be strengthened.3.Although endovascular treatment is the first choice for patients with acute ischemic stroke,the benefits of endovascular treatment for acute ischemic stroke decrease with age.