Outside Hospital Transfer Significantly Influences Clinical Outcomes in Octogenarians Undergoing Endovascular Thrombectomy for Vertebrobasilar Artery Occlusions
Lucas Rios Rocha1, Mohamed Fahmy Doheim1, Alhamza Al-Bayati2, Abdullah Al-Qudah1, Nirav Bhatt2, Matthew Starr2, Anmol Almast1, Jussie Correia Lima2, Michael Lang2, Bradley Gross2, Raul Nogueira2, Marcelo Rocha2
1University of Pittsburgh, 2UPMC Stroke Institute
Objective:
To assess the impact of age (<80 vs. ≥80 years) and presenting site (hub vs. spoke) on clinical outcomes in patients undergoing endovascular thrombectomy (EVT) for vertebrobasilar artery occlusions (VBAOs).
Background:
EVT is the standard treatment for acute ischemic stroke caused by large vessel occlusions. This study investigates how age and the site of presentation influence outcomes in VBAO patients treated within hub-and-spoke networks.
Design/Methods:
A retrospective analysis was conducted on patients with VBAOs treated with EVT at a comprehensive stroke center. Patients were categorized into two age groups (<80 years and ≥80 years) and by presenting site (Hub vs. Spoke). Primary outcomes included modified Rankin Scale (mRS ≤3) at 90 days and mortality. Interaction effects were evaluated using logistic regression.
Results:
A total of 175 patients were included, with 48 (27.4%) in the Hub group and 127 (72.6%) in the Spoke group. Among these, 37 (21.1%) were aged ≥80 years. For patients <80 years, mRS ≤3 at 90 days was observed in 52.27% (46/88) of the Hub group and 39.47% (15/38) of the Spoke group (p=0.187). In octogenarians (≥80 years), mRS ≤3 was 50.00% (4/8) in the Hub group and 19.23% (5/26) in the Spoke group, with a significant interaction (p-value for interaction =0.02). Mortality at 90 days was 36.36% in patients <80 years in the Hub group vs. 50.00% in the Spoke group, whereas for octogenarians, mortality was 50.00% (Hub) vs. 73.08% (Spoke), (p-value for interaction =0.074).
Conclusions:
Octogenarians with acute VBAOs treated with EVT who presented directly to the hub experienced significantly improved outcomes compared to those first presenting to a spoke hospital. These findings suggest that older patients with VBAO stroke may have reduced tolerance to outside transfers for EVT. Further research is needed to validate these results and prioritize transfer protocols for older populations undergoing EVT for VBAOs.
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