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Table of Contents
Vol. 31, No. 6, 2011
Issue release date: May 2011
Section title: Original Paper
Cerebrovasc Dis 2011;31:559–565
(DOI:10.1159/000324626)

Impact of a Combined Intravenous/ Intra-Arterial Approach in Octogenarians

Mazighi M.a, c · Labreuche J.c · Meseguer E.a, c · Serfaty J.-M.b · Laissy J.-P.b · Lavallée P.C.a, c · Cabrejo L.a, c · Guidoux C.a, c · Lapergue B.a, c · Klein I.F.b, c · Olivot J.-M.a · Abboud H.a · Simon O.a · Schouman-Claeys E.b · Amarenco P.a, c
aDepartment of Neurology and Stroke Centre and bDepartment of Radiology, Bichat University Hospital, and cINSERM U-698 and Paris-Diderot University, Paris, France

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 23, 2010
Accepted: January 25, 2011
Published online: April 12, 2011
Issue release date: May 2011

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: Intravenous (IV) alteplase is not currently recommended in octogenarian patients, and the benefit/risk ratio of endovascular (intra-arterial, IA) therapy remains to be determined. The aim of this study was to determine the impact of a combined IV-IA approach in octogenarians. Methods: From a single-centre interventional study, we report age-specific outcomes of patients treated by a combined IV-IA thrombolytic approach. Patients ≧80 years with documented arterial occlusion treated by conventional IV thrombolysis constituted the control group. Results: Among 84 patients treated by the IV-IA approach, those ≧80 years (n = 25) had a similar rate of early neurological improvement to that of patients <80 years, whereas the 90-day favourable outcome rate was lower in octogenarians (adjusted odds ratio, OR, 0.21; 95% confidence interval, CI, 0.06–0.75). No difference in symptomatic intracranial haemorrhage was observed whereas a higher rate of 90-day mortality (adjusted OR, 3.27; 95% CI, 0.76–14.14) and asymptomatic intracranial haemorrhage (adjusted OR, 6.39; 95% CI, 1.54–26.63) were found in patients ≧80 years old. Among octogenarians, and compared to IV-thrombolysis-treated patients (n = 24), patients treated by the IV-IA approach had a higher rate of recanalization (76 vs. 33%, p = 0.003) associated with increased early neurological improvement (32 vs. 8%, p = 0.07). Although there was a higher rate of asymptomatic intracranial haemorrhage (44 vs. 8%, p = 0.005) observed in the IV-IA group, no difference existed in symptomatic intracranial haemorrhage rates and 90-day favourable outcome. Conclusion: The IV-IA approach in octogenarians was associated with lower efficacy at 3 months and higher mortality and asymptomatic haemorrhagic complications than in patients <80 years old. Definite recommendations cannot be given, but an endovascular approach may cause more harm than positive effects in patients over 80 years and should not be considered outside an approved protocol.

© 2011 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 23, 2010
Accepted: January 25, 2011
Published online: April 12, 2011
Issue release date: May 2011

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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