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

Version 2 2024-06-04, 06:24
Version 1 2021-06-18, 10:48
journal contribution
posted on 2024-06-04, 06:24 authored by H Janssen, S Nannoni, O Francois, T Dewaele, S De Blauwe, G Vanhooren, J Ghekiere, J Kager, A Peeters, P Goffette, F Hammer, T Duprez, J Demeestere, R Lemmens, S Cornelissen, S Heye, L Yperzeele, I Baar, M Voormolen, T Van der Zijden, A Mondelaers, T Andersson, H Pottel, C Odier, F Karkri, P Michel, P Vanacker
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.

History

Journal

Journal of Stroke and Cerebrovascular Diseases

Volume

29

Article number

ARTN 104817

Pagination

1 - 8

Location

United States

ISSN

1052-3057

eISSN

1532-8511

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Issue

8

Publisher

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