Deans' stroke musings: Is aspiration an effective acute stroke treatment in older adults?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, May 11, 2023

Is aspiration an effective acute stroke treatment in older adults?

The takeaway for you is not to have Carotid tortuosity before you have your stroke.

Also don't be old, hey I had mine at age 50.

Is aspiration an effective acute stroke treatment in older adults?

Jerzy Narloch¹^*,

Adam Piasecki²,

Piotr Ziecina¹,

Aleksander Dȩbiec³,

Marek Wierzbicki¹,

Jacek Staszewski³ and

Piotr Piasecki¹

¹Department of Interventional Radiology, Military Institute of Medicine–National Research Institute, Warsaw, Poland
²Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
³Department of Neurology, Military Institute of Medicine–National Research Institute, Warsaw, Poland

Introduction: Clinical outcomes after interventional stroke treatment rely on several factors, with older age being associated with poorer results, which are mainly attributed to patient's comorbidities and medications. The delivery of an aspiration catheter could be hindered by carotid tortuosity, which is more prevalent in elderly patients with increasing age. In this study, we aimed to compare the clinical and angiographic outcomes of a direct aspiration first-pass technique in interventional stroke treatment for elderly patients compared with younger patients.

Materials and methods: A total of 162 patients (92 women and 70 men, aged between 35 and 94 years +/– 12.4 years) were included in this study. Patients who were treated in a comprehensive stroke center due to a large-vessel occlusion stroke using aspiration as the first-choice treatment were included in this study. To evaluate carotid arteries, the tortuosity index (TI) was calculated for each segment of each carotid pathway.

Results: Age correlated significantly with the presence of carotid tortuosity (R = 0.408, p = 0.000), extracranial length ratio (R = 0.487, p = 0.000), and overall length ratio (R = 0.467, p = 0.000). No significant associations were found with coiling, kinking, or intracranial length ratio. Successful aspiration-based recanalization rate decreased with increasing age, and the differences between the age subgroups were not statistically significant. A comparison of the extreme subgroups, i.e., <60 years old vs. ≥80 years old, did not yield a statistically significant change (p = 0.068).

Conclusion: Successful aspiration-based recanalization rate decreased with increasing age; however, these differences were not significant. Clinical outcomes did not significantly differ with regard to carotid tortuosity, regardless of the time of assessment. Neither intracranial nor extracranial tortuosity was significantly associated with reperfusion-related complications in either of the age subgroups.

Introduction

Clinical outcomes after interventional stroke treatment rely on several factors. Older age is associated with poorer results, which are mainly attributed to patient's comorbidities and medications. Successful recanalization after a single retrieval maneuver is the primary goal of treatment in cases of acute ischemic stroke, and it is an independent factor for good clinical outcomes, regardless of age (1–4).

The results of the ASTER and COMPASS trials have established that, compared with stent-retriever-based techniques, “a direct aspiration first-pass technique” (ADAPT) was a non-inferiority trial in terms of successful recanalization and functional outcomes. Moreover, ADAPT has gained an increasing number of proponents due to its lower cost and faster procedure time (5–7).

Carotid tortuosity, which becomes more prevalent with increasing age, can hinder the delivery of the aspiration catheter (8). Moreover, the navigation of aspiration catheters is further impeded by the branching of the parent artery (in particular, the ophthalmic branch of the internal carotid artery [ICA]). Unfavorable anatomy poses technical challenges that lead to increased procedure time and delays in reperfusion, which affect patient outcomes (5, 8–10).

In this study, we aimed to compare the clinical and angiographic outcomes of elderly patients who received ADAPT as part of interventional stroke treatment with the clinical and angiographic outcomes of younger patients.