Endovascular Treatment of Very Elderly Patients Aged ≥90 With Acute Ischemic Stroke
Authors: Meyer Lukas , Alexandrou Maria , Flottmann Fabian , Deb‐Chatterji Milani , Abdullayev Nuran , Maus Volker , Politi Maria , Bernkopf Kathleen , Roth Christian , Kastrup Andreas , Hanning Uta , Brekenfeld Caspar , Thomalla Götz , Gerloff Christian , Mpotsaris Anastasios , Papanagiotou Panagiotis , Fiehler Jens , Leischner Hannes , Wunderlich Silke , Boeckh‐Behrens Tobias , Reich Arno , Wiesmann Martin , Ernemann Ulrike , Hauser Till‐Karsten , Siebert Eberhard , Nolte Christian , Zweynert Sarah , Bohner Georg , Ludolph Alexander , Henn Karl‐Heinz , Pfeilschifter Waltraud , Wagner Marlis , Röther Joachim , Eckert Bernd , Berrouschot Jörg , Bormann Albrecht , Alegiani Anna , Hattingen Elke , Petzold Gabor , Thonke Sven , Bangard Christopher , Kraemer Christoffer , Dichgans Martin , Wollenweber Frank , Kellert Lars , Dorn Franziska , Herzberg Moriz , Psychogios Marios , Liman Jan , Petersen Martina , Stögbauer Florian , Kraft Peter , Pham Mirko , Braun Michael , Hamann Gerhard F. , Gröschel Klaus , Uphaus Timo , Limmroth Volker 
Published: February 2020

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.