Clinical Interventions in Aging (Jul 2016)
First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting
Abstract
Chih-Ming Lin,1,2 Yu-Jun Chang,3 Chi-Kuang Liu,4 Cheng-Sheng Yu,5 Henry Horng-Shing Lu5 1Department of Neurology, Stroke Center, Changhua Christian Hospital, Changhua, 2Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, 3Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, 4Department of Medical Imaging, Changhua Christian Hospital, Changhua, 5Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, Taiwan Abstract: Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[-]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[-] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(-) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and admission hsCRP could serve as important predictors of mRS improvement and may facilitate differentiation of patients at baseline. Keywords: modified Rankin scale, resistance index, Barthel index, common carotid artery, cerebral blood volume ratio
