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The related main theme: A. Stroke and Cerebral vascular disorders

年齡在腦中風病人接受動脈取栓之研究

The Age Factor Influencing Long Term Physical Functionality in Stroke Patients Undergoing Intra-arterial Thrombetomy Treatment

Authers:

高季伶,  2 , 林志明, PhD, MD 1, 3, 5 , 張淑微, PhD 3 , 劉繼光, MD 4 , 歐陽豪, MD 1 , 盧鴻興, PhD 2 , 
Chi-Ling  Kao,  2 , Chih-Ming  Lin, PhD, MD 1, 3 , Shu-Wei  Chang, PhD 3 , Chi-Kuang  Liu, MD 4 , Yang-Hao  Ou, MD 1 , Henry Horng-Shing  Lu, PhD 2 , 
1 彰化基督教醫院 神經部
2 國立交通大學 統計學研究所
3 大葉大學 藥用植物與保健學系
4 彰化基督教醫院 神經影像醫學部
5 靜宜大學 社會工作與兒童少年福利學系
1 Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan
2 Institute of Statistics, National Chiao Tung University, Hsinchu City, Taiwan
3 Department of Medicinal Botanicals and Health Applications, Dayeh University, Changhua County, Taiwan
4 Department of Neuroimaging, Changhua Christian Hospital, Changhua City, Taiwan
5 Department of Social Work and Child Welfare, Providence University, Taichung City, Taiwan
Corresponding Author:

盧鴻興
Henry Horng-Shing  Lu , PhD
國立交通大學 統計學研究所
Institute of Statistics, National Chiao Tung University, Hsinchu City, Taiwan

keywords: Age, Intravenous thrombolysis, intra-arterial thrombectomy, resistance index, pulsatility index, acute ischemic stroke
Abstract for original article

OBJECTIVES /BACKGROUND:
The treatment of acute ischemic stroke is heavily time-dependent, and even though, with the most efficient treatment, the long-term functional outcome is still highly variable. In this current study, the authors selected acute ischemic stroke patients who were qualified for intravenous thrombolysis with recombinant tissue plasminogen activator and followed by intra-arterial thrombectomy. With primary outcome defined by the functional level in a one-year follow-up, we hypothesize that patients with older age are at a disadvantage in post-stroke recovery. However, an age-threshold should be determined to help clinicians in selection of patients to undergo such therapy.

MATERIAL and METHOD:
This is a retrospective chart review study that include 92 stroke patients in Changhua Christian hospital with a total of 68 evaluation indexes recorded. The current study utilized the forward stepwise regression model whose Adj-R2 and p-value in search of important variables for outcome prediction. The chngpt package in R indicated the threshold point of the age factor directing the better future functionality of the stroke patients.

RESULT:
Datasets revealed the threshold of the age set at 79 the most appropriate. Admission Barthel Index, Age, ipsilateral ICA RI, and VA PI, as well as contralateral MCA stenosis, ECA RI, and in-hospital pneumonia are the significant predicting variables. The higher the age, in-hospital pneumonia, contralateral MCA stenosis, ipsilateral ICA RI and VA PI, the less likely patient to recover from functional deficits as the result of acute ischemic stroke; the higher the value of contralateral ECA RI and admission Barthel Index, the better chance to recover at one-year follow up.

DISCUSSION:
Parameters of pre-intervention datasets could provide important information to aid first-line clinicians in decision making. Especially, in patients whose age is above seventy-nine receives diminish return in the benefit to undergo such intervention and should be considered seriously by both the patients and the physicians.


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