Objective:

To define the relationship between older age and clinical core mismatch (CCM) among patients with acute anterior circulation large vessel occlusion (ACLVO) stroke.

Background:

Older ACLVO stroke patients experience worse functional outcomes.  Presence of CCM indicates discordance of clinical severity and ischemic core volume, suggesting salvageable penumbra on hospital arrival.  However, the impact of older age on CCM is unclear.

Design/Methods:

Retrospective study of patients with acute intracranial ICA or MCA occlusion in 2014-2019, included if they had baseline advanced imaging within 24 hours after last known well (LKW) time.  Prevalence of CCM1 (NIHSS ≥ 10 and core ≤20 ml) and CCM2 (NIHSS ≥10 and core ≤31 ml) were compared across age tertiles and LKW to imaging time (LKWT: 0-24, ≤6 or 6-24 hours). Multivariable logistic regression tested the association between age and CCM, adjusted for LKWT, sex and vascular risk factors.

Results:

312 patients were included (age tertiles [AT1-3]: 33-66, 67-81, and 82-102 years; 57% women; median NIHSS 17 [IQR, 12-21] and core 12.5 ml [IQR, 0-58]). The CCM prevalence was higher in older age for CCM1 (%: AT1, 33; AT2, 44.6; AT3, 52; P=0.02) and CCM2 (%: AT1, 39; AT2, 47.3; AT3, 56; P=0.055) within 0-24 hours, with similar distribution at ≤6 or 6-24 hours of LKWT. On logistic regression adjusted for LKWT, increasing age (per decade) was associated with CCM-1 (OR 1.27, 95% CI 1.08-1.49, P<0.01) and CCM2 (OR 1.19, 95% CI 1.02-1.39, P=0.02). On multivariable analysis, there was a strong association trend between increasing age (per decade) and CCM-1 (OR 1.2, 95% CI 0.99-1.44, P=0.05) but not CCM2 (OR 1.11, 95% CI 0.92-1.32, P=0.26).

Conclusions:

Advanced age was associated with higher CCM prevalence in acute ACLVO stroke, independently of early or delayed presentation, supporting the notion that older patients should be given especially careful consideration for endovascular therapies.