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

Lukas Meyer, Maria Alexandrou, Fabian Flottmann, Milani Deb-Chatterji, Nuran Abdullayev, Volker Maus, Maria Politi, Kathleen Bernkopf, Christian Roth, Andreas Kastrup, Uta Hanning, Caspar Brekenfeld, Götz Thomalla, Christian Gerloff, Anastasios Mpotsaris, Panagiotis Papanagiotou, Jens Fiehler, Hannes Leischner, German Stroke Registry–Endovascular Treatment (GSR‐ET) †, Silke Wunderlich, Tobias Boeckh-Behrens, Arno Reich, Martin Wiesmann, Ulrike Ernemann, Till-Karsten Hauser, Eberhard Siebert, Christian Nolte, Sarah Zweynert, Georg Bohner, Alexander Ludolph, Karl-Heinz Henn, Waltraud Pfeilschifter, Marlis Wagner, Joachim Röther, Bernd Eckert, Jörg Berrouschot, Albrecht Bormann, Anna Alegiani, Elke Hattingen, Gabor Petzold, Sven Thonke, Christopher Bangard, Christoffer Kraemer, Martin Dichgans, Frank Wollenweber, Lars Kellert, Franziska Dorn, Moriz Herzberg, Marios Psychogios, Jan Liman, Martina Petersen, Florian Stögbauer, Peter Kraft, Mirko Pham, Michael Braun, Gerhard F Hamann, Klaus Gröschel, Timo Uphaus, Volker Limmroth, Lukas Meyer, Maria Alexandrou, Fabian Flottmann, Milani Deb-Chatterji, Nuran Abdullayev, Volker Maus, Maria Politi, Kathleen Bernkopf, Christian Roth, Andreas Kastrup, Uta Hanning, Caspar Brekenfeld, Götz Thomalla, Christian Gerloff, Anastasios Mpotsaris, Panagiotis Papanagiotou, Jens Fiehler, Hannes Leischner, German Stroke Registry–Endovascular Treatment (GSR‐ET) †, Silke Wunderlich, Tobias Boeckh-Behrens, Arno Reich, Martin Wiesmann, Ulrike Ernemann, Till-Karsten Hauser, Eberhard Siebert, Christian Nolte, Sarah Zweynert, Georg Bohner, Alexander Ludolph, Karl-Heinz Henn, Waltraud Pfeilschifter, Marlis Wagner, Joachim Röther, Bernd Eckert, Jörg Berrouschot, Albrecht Bormann, Anna Alegiani, Elke Hattingen, Gabor Petzold, Sven Thonke, Christopher Bangard, Christoffer Kraemer, Martin Dichgans, Frank Wollenweber, Lars Kellert, Franziska Dorn, Moriz Herzberg, Marios Psychogios, Jan Liman, Martina Petersen, Florian Stögbauer, Peter Kraft, Mirko Pham, Michael Braun, Gerhard F Hamann, Klaus Gröschel, Timo Uphaus, Volker Limmroth

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.

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.

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Source: PubMed

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