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Ischemic Stroke
Original research
Thrombectomy for acute ischemic stroke in nonagenarians compared with octogenarians
  1. Eric S Sussman1,
  2. Blake Martin2,
  3. Michael Mlynash3,
  4. Michael P Marks1,
  5. David Marcellus2,
  6. Gregory Albers3,
  7. Maarten Lansberg3,
  8. Robert Dodd1,
  9. Huy M Do1,
  10. Jeremy J Heit1
  1. 1 Neurosurgery and Radiology, Stanford University Medical Center, Stanford, California, USA
  2. 2 Department of Radiology, Stanford University, Stanford, California, USA
  3. 3 Department of Neurology, Stanford Stroke Center, Stanford University, Stanford, California, USA
  1. Correspondence to Eric S Sussman, Neurosurgery and Radiology, Stanford University Medical Center, Stanford, California, USA; esuss11{at}gmail.com

Abstract

Introduction Multiple randomized trials have shown that endovascular thrombectomy (EVT) leads to improved outcomes in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Elderly patients were poorly represented in these trials, and the efficacy of EVT in nonagenarian patients remains uncertain.

Methods We performed a retrospective cohort study at a single center. Inclusion criteria were: age 80–99, LVO, core infarct <70 mL, and salvageable penumbra. Patients were stratified into octogenarian (80–89) and nonagenarian (90–99) cohorts. The primary outcome was the ordinal score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included dichotomized functional outcome (mRS ≤2 vs mRS ≥3), successful revascularization, symptomatic intracranial hemorrhage (ICH), and mortality.

Results 108 patients met the inclusion criteria, including 79 octogenarians (73%) and 29 nonagenarians (27%). Nonagenarians were more likely to be female (86% vs 58%; p<0.01); there were no other differences between groups in terms of demographics, medical comorbidities, or treatment characteristics. Successful revascularization (TICI 2b–3) was achieved in 79% in both cohorts. Median mRS at 90 days was 5 in octogenarians and 6 in nonagenarians (p=0.09). Functional independence (mRS ≤2) at 90 days was achieved in 12.5% and 19.7% of nonagenarians and octogenarians, respectively (p=0.54). Symptomatic ICH occurred in 21.4% and 6.4% (p=0.03), and 90-day mortality rate was 63% and 40.9% (p=0.07) in nonagenarians and octogenarians, respectively.

Conclusions Nonagenarians may be at higher risk of symptomatic ICH than octogenarians, despite similar stroke- and treatment-related factors. While there was a trend towards higher mortality and worse functional outcomes in nonagenarians, the difference was not statistically significant in this relatively small retrospective study.

  • ischemic stroke
  • endovascular thrombectomy
  • nonagenarian
  • perfusion imaging

https://doi.org/10.1136/neurintsurg-2019-015147

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    Footnotes

    • ESS and BM contributed equally.

    • Contributors Each of the authors listed on this manuscript contributed substantially to the study design, data collection, data analysis, and manuscript review. Each of the authors has reviewed the final manuscript and has agreed with the submission of this manuscript to JNIS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.