Online first
Research Paper
Published online: 2024-07-12
Mechanical thrombectomy in very elderly people: shortand long-term outcomes of endovascular stroke treatment in nonagenarians
DOI: 10.5603/pjnns.99386
Pubmed: 38994832
Abstract
Aim of study. To assess outcomes of mechanical thrombectomy (MT) in nonagenarians suffering from acute ischaemic stroke (AIS) in a 1-year follow-up. Clinical rationale for study. Age is a factor associated with both the occurrence of AIS and a poorer prognosis. As the population ages, the prevalence of AIS among the very old (90 and older) is expected to rise. Data on long-term outcomes of MT, being the optimal treatment of AIS caused by large vessel occlusions, is scarce in the population of nonagenarians.
Material and methods. We analysed all AIS patients treated with MT in a single Comprehensive Stroke Centre. We compared two subgroups: nonagenarians (people aged 90–99) and controls ( < 90 years) in terms of cardiovascular risk factors profile, stroke severity, treatment course, presence of in-hospital complications, and outcomes (mortality and good functional outcome defined as modified Rankin Scale ≤ 2) at discharge and at 90- and 365-day follow-ups.
Results. Nonagenarians were more commonly female and suffering from atrial fibrillation. They more often developed urinary tract infection during hospitalisation. Stroke severity, treatment course and in-hospital outcomes were comparable between the groups. Nonagenarians had non-significantly higher 90-day and 365-day mortality, and a significantly lower rate of good functional outcomes after 90 days (25.0% vs 57.7%, p = 0.011) and 365 days (31.5% vs 61.0%, p = 0.020).
Conclusions and clinical implications. Despite worse outcomes than in younger patients, 25% of nonagenarians were functionally independent three months after MT, and almost one in three of them were so a year after the procedure, thereby showing the benefits of the treatment in this group.
Keywords: acute ischaemic strokemechanical thrombectomyendovascular stroke treatmentagenonagenarians
References
- Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10): e56–e528.
- Al-Holou WN, Khan A, Wilson TJ, et al. Incidental findings on cranial imaging in nonagenarians. Neurosurg Focus. 2011; 31(6): E11.
- United Nations, Department of Economic and Social Affairs, Population Division (2018) World Population Prospects: The 2017 Revision. Vol. I: Comprehensive Tables: World Population Prospects: The 2017 Revision; 2018 IIS 3080-S22.1; ST/ESA/SER.A/399. n.d.
- Kammersgaard LP, Jørgensen HS, Reith J, et al. Copenhagen Stroke Study. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004; 33(2): 149–154.
- Pana TA, Perdomo-Lampignano JA, Myint PK. Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues. Curr Treat Options Neurol. 2019; 21(6): 27.
- Turc G, Bhogal P, Fischer U, et al. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE). Eur Stroke J. 2019; 4(1): 6–12.
- Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; 6(1): I–LXII.
- Goyal M, Menon BK, van Zwam WH, et al. HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387(10029): 1723–1731.
- Michelard M, Detante O, Heck O, et al. Thrombolysis and thrombectomy for stroke in octogenarians and nonagenarians: A regional observational study. Rev Neurol (Paris). 2023; 179(10): 1068–1073.
- Gomes C, Barcelos V, Guiomar V, et al. Outcomes of reperfusion therapy for acute ischaemic stroke in patients aged 90 years or older: a retrospective study. Intern Emerg Med. 2021; 16(1): 101–108.
- Caruso JP, Wu E, Vance AZ, et al. Does endovascular therapy change outcomes in nonagenarians with acute ischemic stroke? J Clin Neurosci. 2020; 78: 207–210.
- Friedman I, Naftali J, Pardo K, et al. Efficacy and safety of endovascular treatment in patients older than 90 with acute ischemic stroke: A retrospective cohort study. Front Neurol. 2022; 13: 1097423.
- Rotschild O, Honig A, Hallevi H, et al. Endovascular thrombectomy is beneficial for functional nonagenarians - a multicenter cohort analysis. J Stroke Cerebrovasc Dis. 2022; 31(10): 106699.
- Rahangdale R, Hackett CT, Cerejo R, et al. Outcomes of endovascular thrombectomy in patients selected by computed tomography perfusion imaging - a matched cohort study comparing nonagenarians to younger patients. J Neurointerv Surg. 2022; 14(8): 747–751.
- Agarwal S, Huang J, Scher E, et al. Mechanical Thrombectomy in Nonagenarians: A Propensity Score Matched Analysis. J Stroke Cerebrovasc Dis. 2020; 29(7): 104870.
- Hendrix P, Killer-Oberpfalzer M, Broussalis E, et al. Outcome Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke in the Elderly. Clin Neuroradiol. 2022; 32(2): 369–374.
- Kawaji H, Tomoto K, Arakawa T, et al. Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients. Neurol Med Chir (Tokyo). 2021; 61(7): 397–403.
- Andrews CE, Mouchtouris N, Fitchett EM, et al. Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients. J Neurosurg. 2019; 132(4): 1182–1187.
- Khan MA, Baird GL, Miller D, et al. Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort. J Neurointerv Surg. 2017; 9(8): 727–731.
- Sweid A, Weinberg JH, Xu V, et al. Mechanical Thrombectomy in Acute Ischemic Stroke Patients Greater than 90 Years of Age: Experience in 26 Patients in a Large Tertiary Care Center and Outcome Comparison with Younger Patients. World Neurosurg. 2020; 133: e835–e841.
- Tsuji Y, Miki T, Kakita H, et al. Clinical Results of Mechanical Thrombectomy in Nonagenarians with Acute Ischemic Stroke. J Neuroendovasc Ther. 2020; 14(8): 295–300.
- Derraz I, Benali A, Ahmed R, et al. Impact of endovascular reperfusion therapy in nonagenarians with anterior circulation large-vessel ischaemic stroke. Age Ageing. 2021; 50(3): 787–794.
- Sussman ES, Martin B, Mlynash M, et al. Thrombectomy for acute ischemic stroke in nonagenarians compared with octogenarians. J Neurointerv Surg. 2020; 12(3): 266–270.
- Salhadar N, Dibas M, Sarraj A, et al. The outcomes of mechanical thrombectomy in nonagenarians and octogenarians in a majority hispanic population. Clin Neurol Neurosurg. 2021; 208: 106872.
- Pinto MM, Nunes AP, Alves M, et al. Mechanical thrombectomy in stroke in nonagenarians: useful or futile? J Stroke Cerebrovasc Dis. 2020; 29(9): 105015.
- Tonetti DA, Gross BA, Desai SM, et al. Final Infarct Volume of <10 cm is a Strong Predictor of Return to Home in Nonagenarians Undergoing Mechanical Thrombectomy. World Neurosurg. 2018; 119: e941–e946.
- Janssen H, Nannoni S, Francois O, et al. Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians. J Stroke Cerebrovasc Dis. 2020; 29(8): 104817.
- Inoue M, Ota T, Hara T, et al. An Initial High National Institutes of Health Stroke Scale Score and Any Intracranial Hemorrhage Are Independent Factors for a Poor Outcome in Nonagenarians Treated with Thrombectomy for Acute Large Vessel Occlusion: The Tokyo/Tama-REgistry of Acute Endovascular Thrombectomy (TREAT) Study. World Neurosurg. 2022; 165: e325–e330.
- Derraz I, Ahmed R, Benali A, et al. FLAIR vascular hyperintensities and functional outcome in nonagenarians with anterior circulation large-vessel ischemic stroke treated with endovascular thrombectomy. Eur Radiol. 2021; 31(10): 7406–7416.
- Rousiers EDd, Lucas L, Richard S, et al. Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy. Stroke. 2019; 50(11): 3164–3169.
- Sojka M, Szmygin M, Pyra K, et al. Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years. Clin Neurol Neurosurg. 2021; 200: 106354.
- Meyer L, Alexandrou M, Leischner H, et al. Mechanical thrombectomy in nonagenarians with acute ischemic stroke. J Neurointerv Surg. 2019; 11(11): 1091–1094.
- Jumah F, Raju B, Ginalis EE, et al. Outcomes of Mechanical Thrombectomy for Ischemic Stroke in Nonagenarians: A 10-Year Institutional Experience. J Stroke Cerebrovasc Dis. 2022; 31(3): 106106.
- Wu Q, Li Qi, Huang C, et al. Efficacy and Safety of Endovascular Thrombectomy for Ischemic Stroke in Nonagenarians. Eur Neurol. 2019; 81(3-4): 174–181.
- van Horn N, Kniep H, Leischner H, et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients. J Neurointerv Surg. 2021; 13(1): 14–18.
- Włodarczyk E, Sawczyńska K, Wrona P, et al. Reversing dabigatran effect with idarucizumab to enable intravenous thrombolysis in patients with acute ischaemic stroke - a single centre experience. Neurol Neurochir Pol. 2023; 57(6): 465–476.
- Inoue H, Oomura M, Nishikawa Y, et al. Successful Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion in a Centenarian. Cureus. 2022; 14(2): e22071.
- Bai X, Zhang X, Zhang Y, et al. Mechanical Thrombectomy in Nonagenarians: a Systematic Review and Meta-analysis. Transl Stroke Res. 2021; 12(3): 394–405.
- Meyer L, Alexandrou M, Flottmann F, et al. German Stroke Registry–Endovascular Treatment (GSR‐ET) †. Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke. J Am Heart Assoc. 2020; 9(5): e014447.
