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Multicenter Study
. 2020 Aug;29(8):104817.
doi: 10.1016/j.jstrokecerebrovasdis.2020.104817. Epub 2020 Apr 25.

Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians

Helena Janssen  1 , Stefania Nannoni  2 , Olivier Francois  3 , Tom Dewaele  3 , Sofie De Blauwe  4 , Geert Vanhooren  4 , Johan Ghekiere  4 , Joost Kager  4 , André Peeters  5 , Pierre Goffette  5 , Frank Hammer  5 , Thierry Duprez  5 , Jelle Demeestere  6 , Robin Lemmens  6 , Sandra Cornelissen  6 , Sam Heye  6 , Laetitia Yperzeele  7 , Ingrid Baar  7 , Maurits Voormolen  7 , Thijs Van der Zijden  7 , Annelies Mondelaers  7 , Tommy Andersson  8 , Hans Pottel  9 , Céline Odier  10 , Fatine Karkri  10 , Patrik Michel  2 , Peter Vanacker  11
Affiliations
Multicenter Study

Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians

Helena Janssen et al. J Stroke Cerebrovasc Dis. 2020 Aug.

Abstract

Background: With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly.

Methods: Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality.

Results: Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days.

Conclusions: Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.

Keywords: Acute ischemic stroke; clinical outcome; elderly; endovascular treatment; nonagenarians.

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Conflict of interest statement

Disclosures No conflicts of interests to declare: HJ, NS, FO, DT, DBS, VG, GJ, KJ, PA, GP, HF, DT, DJ, LR, CSA, HS, YL, BI, VM, VDZT, MA, PH, OC, KF, VPA. VG is a consultant for Medtronic and Bayer and has received speaker fees from Bayer, Pfizer, AMGEN and travel fees from BI. AT is a consultant for Ablynx, Amnis Therapeutics, Anaconda, Cerenovus-Neuravi, Medtronic and Rapid Medical.MP has received within the last 2 years through his institution research grants from the Swiss Heart Foundation and BMS; speaker fees from Boehringer-Ingelheim, Medtronic, and Amgen; consulting fees from Medtronic and Amgen, and honoraria from scientific advisory boards from Boehringer-Ingelheim, Pfizer and BMS. All this support is used for stroke education and research.

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