TY - JOUR
T1 - Endovascular thrombectomy is beneficial for functional nonagenarians – a multicenter cohort analysis
AU - Rotschild, Ofer
AU - Honig, Asaf
AU - Hallevi, Hen
AU - Horev, Anat
AU - Seyman, Estelle
AU - Ben-Assayag, Einor
AU - Jonas-Kimchi, Tali
AU - Sadeh, Udi
AU - Cohen, Jose
AU - Leker, Ronen R.
AU - Molad, Jeremy
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/10
Y1 - 2022/10
N2 - Introduction: The use of endovascular thrombectomy (EVT) has dramatically increased in recent years. However, most existing studies used an upper age limit of 80 and data regarding the safety and efficacy of EVT among nonagenarians is still lacking. Methods: 767 consecutive patients undergoing EVT for large vessel occlusion (LVO) in three participating centers were recruited into a prospective ongoing database. Demographic, clinical and imaging characteristics were documented. Statistical analysis was done to evaluate EVT outcome among nonagenarians compared to younger patients. Results: The current analysis included 41 (5.4%) patients older than 90 years. Compared to younger patients, nonagenarians were more often female (78% versus 50.3%, p ≤ 0.001), had worse baseline mRS scores (2 [0–3] versus 0 [0–2], p < 0.001), higher rates of hypertension and hyperlipidemia and a higher admission NIHSS (20 [14–23] versus 16 [11–20], p < 0.001). No differences were found between groups regarding the involved vessel, stroke etiology, time from symptoms to door or symptoms to EVT, successful recanalization rates and hemorrhagic transformation rates. Nonagenarians had worse mRS at 90 days (5 [3–6] versus 3 [2–5], p = 0.001), similar discharge NIHSS (5 [1–11] versus 4 [1–11], p = 0.78) and higher mortality rates (36.6% versus 15.8%, p < 0.001). All nonagenarians with baseline mRS 4 have died within 90 days. 36.4% of nonagenarian patients with baseline MRS of 3 or less had favorable outcome. Discussion: This study demonstrates that nonagenarian stroke patients with baseline mRS of 3 or less benefit from EVT with no significant difference in the rate of favorable outcome compared to octogenarians.
AB - Introduction: The use of endovascular thrombectomy (EVT) has dramatically increased in recent years. However, most existing studies used an upper age limit of 80 and data regarding the safety and efficacy of EVT among nonagenarians is still lacking. Methods: 767 consecutive patients undergoing EVT for large vessel occlusion (LVO) in three participating centers were recruited into a prospective ongoing database. Demographic, clinical and imaging characteristics were documented. Statistical analysis was done to evaluate EVT outcome among nonagenarians compared to younger patients. Results: The current analysis included 41 (5.4%) patients older than 90 years. Compared to younger patients, nonagenarians were more often female (78% versus 50.3%, p ≤ 0.001), had worse baseline mRS scores (2 [0–3] versus 0 [0–2], p < 0.001), higher rates of hypertension and hyperlipidemia and a higher admission NIHSS (20 [14–23] versus 16 [11–20], p < 0.001). No differences were found between groups regarding the involved vessel, stroke etiology, time from symptoms to door or symptoms to EVT, successful recanalization rates and hemorrhagic transformation rates. Nonagenarians had worse mRS at 90 days (5 [3–6] versus 3 [2–5], p = 0.001), similar discharge NIHSS (5 [1–11] versus 4 [1–11], p = 0.78) and higher mortality rates (36.6% versus 15.8%, p < 0.001). All nonagenarians with baseline mRS 4 have died within 90 days. 36.4% of nonagenarian patients with baseline MRS of 3 or less had favorable outcome. Discussion: This study demonstrates that nonagenarian stroke patients with baseline mRS of 3 or less benefit from EVT with no significant difference in the rate of favorable outcome compared to octogenarians.
KW - Endovascular thrombectomy
KW - Ischemic stroke
KW - Mechanical thrombectomy
KW - Nonagenarians
UR - http://www.scopus.com/inward/record.url?scp=85138566247&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2022.106699
DO - 10.1016/j.jstrokecerebrovasdis.2022.106699
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C2 - 36054973
AN - SCOPUS:85138566247
SN - 1052-3057
VL - 31
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 10
M1 - 106699
ER -