Dataset Information

Advanced age is associated with increased adverse outcomes in patients undergoing middle cerebral artery stenting.

ABSTRACT:

Purpose

This study tried to evaluate whether advanced age has an increased incidence of major complications in patients undergoing MCA stenting.

Methods

A total of 348 patients who underwent MCA stenting were reviewed from a prospectively maintained database. Ninety-day ischemic stroke, intracerebral hemorrhage, and death outcomes were compared among the young (≤40 years old), middle (41-60 years old) and old (≥61 years old) groups. Univariate analysis and multivariable logistic regression analysis were used to investigate different variables associated with 90-day major adverse events. Kaplan-Meier analysis was performed to determine long-term outcomes during follow-up.

Results

The incidence of 90-day ischemic stroke was 9.26% in the old group, 2.86% in the middle group, and 0% in the young group (P = 0.024). The incidence of all 90-day major adverse events was 3.33% in patients ≤40 years old, 19.90% in patients 41-60 years old, and 24.07% in patients ≥61 years old, with statistical significance (P = 0.04). Advanced age was associated with increased 90-day ischemic stroke (OR = 1.074, 95% CI: 1.019-1.132, P = 0.007; adjusted OR: 1.071, 95% CI: 1.008-1.138, P = 0.026) and 90-day death (OR = 1.072, 95% CI: 1.012-1.135, P = 0.018; adjusted OR: 1.095, 95% CI: 1.015-1.182, P = 0.018). Meanwhile, advanced age was also associated with decreased long-term survival and ischemic stroke-free survival during follow-up.

Conclusion

Our data indicated that MCA stenting in elderly patients is associated with a high risk of adverse events and should be cautiously considered.

SUBMITTER: Wang G

PROVIDER: S-EPMC9889558 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Advanced age is associated with increased adverse outcomes in patients undergoing middle cerebral artery stenting.

Wang Gong G Liu Juan J He Shengrong S Zhang Xi X Yang Libai L Gao Fei F Guo Yu Y Xu Rui R

Frontiers in neurology 20230118

<h4>Purpose</h4>This study tried to evaluate whether advanced age has an increased incidence of major complications in patients undergoing MCA stenting.<h4>Methods</h4>A total of 348 patients who underwent MCA stenting were reviewed from a prospectively maintained database. Ninety-day ischemic stroke, intracerebral hemorrhage, and death outcomes were compared among the young (≤40 years old), middle (41-60 years old) and old (≥61 years old) groups. Univariate analysis and multivariable logistic r ...[more]

PMID: 36742056

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Project description:BackgroundPatterns of arterial remodeling may be associated with outcomes in patients with severe middle cerebral artery (MCA) stenosis after endovascular treatment (EVT). This study aims to investigate the potential correlation between arterial remodeling patterns in patients with severe MCA stenosis, and plaque characteristics and procedure-related perforator stroke (PS).MethodsConsecutive patients with MCA atherosclerotic disease who underwent EVT at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023 were retrospectively enrolled in this study. The clinical and surgical data of the patients were evaluated. Remodeling index values >1.05, 0.95-1.05, and <0.95 indicated positive remodeling (PR), intermediate remodeling (IR), and negative remodeling (NR), respectively. Based on the remodeling index values calculated by high-resolution magnetic resonance imaging (HR-MRI), the arterial remodeling patterns were classified as NR or non-NR; non-NR was defined as both PR and IR. The primary endpoint was procedure-related PS. Plaque characteristics included the plaque area, plaque burden, contrast-enhancement ratio, and plaque distribution. Plaque features and the incidence of procedure-related PS were compared between the NR and non-NR groups. Differences in the categorical variables between the patients with NR and non-NR were assessed using the Chi-square test (χ2) or Fisher's exact test. Differences in the continuous variables between the two groups were assessed using the Student t-test or Mann-Whitney U-test.ResultsA total of 65 patients (mean age: 57.6 years) were enrolled in the study. Of the patients, 45 (69.2%) showed NR and 20 (30.8%) showed non-NR. The primary endpoint of procedure-related PS occurred in 3 patients (3/65, 4.6%). On HR-MRI, the entire cohort had a mean plaque area of 10.0 mm2, a mean plaque burden of 92.0 %, and a mean enhancement ratio of 1.3. Compared to the non-NR group, the NR group had a smaller plaque area (9.2 vs. 11.6 mm2, P=0.001). The probability of the primary end point was 15.0% in the non-NR group and 0.0% in the NR group (P=0.026).ConclusionsPS after MCA elective stenting may be related to non-NR based on HR-MRI. Further prospective and multicenter studies need to be conducted to confirm these findings.

Project description:BackgroundMalignant middle cerebral artery infarction (MMI) is associated with a high incidence of severe disability and mortality. Decompressive hemicraniectomy has become a recognized treatment that can improve the prognosis for patients if performed within a certain time window. Nevertheless, despite this intervention, a mortality rate of approximately 20-40% persists following the surgery. The trends and clinical implications of intracranial pressure (ICP) in these situations remain unclear. We aimed to investigate whether intracranial pressure (ICP) trends are associated with clinical outcomes in patients undergoing decompressive hemicraniectomy for MMI.MethodsThis retrospective cohort study included consecutive patients with MMI who underwent decompressive craniectomy and received ICP monitoring after surgery. Using a linear mixed model, we categorized the patients into ICP increase and decrease groups based on the ICP values obtained over 192 h. We then compared the proportion of 3-month favorable outcomes (modified Rankin Scale of 0-4) and mortality rates between these groups.ResultsOf 112 MMI patients who underwent decompressive hemicraniectomy, 66 (58.9%) received invasive ICP monitoring. ICP monitoring was performed for a median of 146.5 h (IQR 72.5-181.8). Among the 66 patients, 37 (56.1%) were in the ICP increase group, and 29 (43.9%) were in the ICP decrease group. During the monitoring period, the initial monitored ICP and peak ICP did not significantly differ between the ICP increase and decrease groups. However, the ICP trend was significantly different between the two groups (P < 0.001). In multivariable logistic regression analyses, the ICP increase group had a significantly lower proportion of 3-month favorable outcomes compared to the ICP decrease group (adjusted OR 0.11; 95% CI, 0.01-0.59; P = 0.019), and significantly higher mortality in the intensive care unit (adjusted OR 6.98; 95% CI, 1.37-54.6; P = 0.031).ConclusionsIn MMI patients, continuous ICP monitoring could be useful for detecting those with an increasing ICP trend that may be associated with unfavorable clinical outcomes.

Dataset Information

Advanced age is associated with increased adverse outcomes in patients undergoing middle cerebral artery stenting.

Purpose

Methods

Results

Conclusion

Publications

Advanced age is associated with increased adverse outcomes in patients undergoing middle cerebral artery stenting.

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