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. 2020 Mar 3;9(5):e014447.
doi: 10.1161/JAHA.119.014447. Epub 2020 Feb 24.

Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke

Lukas Meyer  1 , Maria Alexandrou  2 , Fabian Flottmann  1 , Milani Deb-Chatterji  3 , Nuran Abdullayev  4 , Volker Maus  5 , Maria Politi  2 , Kathleen Bernkopf  6 , Christian Roth  2 , Andreas Kastrup  7 , Uta Hanning  1 , Caspar Brekenfeld  1 , Götz Thomalla  3 , Christian Gerloff  3 , Anastasios Mpotsaris  8 , Panagiotis Papanagiotou  2 , Jens Fiehler  1 , Hannes Leischner  1 ; German Stroke Registry–Endovascular Treatment (GSR‐ET) †
Collaborators, Affiliations

Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke

Lukas Meyer et al. J Am Heart Assoc. .

Abstract

Background Patients aged ≥90 were excluded or under-represented in past thrombectomy trials; thus, uncertainty remains whether treatment benefits can be expected regardless of age. This study investigates outcome and safety of thrombectomy in nonagenarians to improve decision making in a real-world setting. Methods and Results All currently available data of patients aged ≥90 enrolled in the GSR-ET (German Stroke Registry-Endovascular Treatment) were combined with a smaller cohort from 3 tertiary stroke centers. Baseline characteristics, procedural (Thrombolysis in Cerebral Infarction scale) and functional outcomes (modified Rankin Scale; mRS), as well as complications (symptomatic intracranial hemorrhage, serious adverse events; SAEs) were analyzed. Good functional outcome was defined as mRS ≤3 at 90-days. 203 patients with anterior circulation stroke and prestroke mRS ≤3 were included. The rate of successful recanalization (Thrombolysis in Cerebral Infarction scale ≥2b) was 75.9% (154/203). Good functional outcome (mRS ≤3) was observed in 21.6% (41 of 193) at 90-days. In-hospital mortality was 27.1% (55 of 203) and increased significantly at 90 days to 48.9% (93 of 190; P<0.001). Symptomatic intracranial hemorrhage occurred in 3% (6 of 203) of patients. Logistic regression analysis identified Alberta Stroke Program Early CT Score (adjusted odds ratio, 1.93; 95% CI, 1.01-3.70; P=0.046) and initial National Institute of Health Stroke Scale (adjusted odds ratio, 0.85; 95% CI, 0.76-0.97; P=0.014) as independent predictors for good outcome. Patients with successful recanalization had a significant (P=0.001) shift of mRS distribution with higher rates of good functional outcomes (23.8% [34 of 143] versus 14.9% [7 of 47]) and lower mortality at 90-days (46.8% [67 of 143] versus 55.3% [26 of 47]). Conclusions Despite high mortality and less frequent favorable outcome, our data suggest that thrombectomy is still effective and safe for nonagenarians. Decision making for thrombectomy in patients aged ≥90 should be based on a case-by-case basis with regard to initial National Institute of Health Stroke Scale and Alberta Stroke Program Early CT Score.

Keywords: elderly; ischemic stroke; nonagenarians; thrombectomy.

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Figures

Figure 1
Figure 1
Distribution of modified Rankin Scale (mRS) scores at 90 days according to recanalization status. TICI indicates thrombolysis in Cerebral Infarction scale.
See this image and copyright information in PMC

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