Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy
Authors: Drouard-de Rousiers Eve , Lucas Ludovic , Richard Sébastien , Consoli Arturo , Mazighi Mikaël , Labreuche Julien , Kyheng Maéva , Gory Benjamin , Dargazanli Cyril , Arquizan Caroline , Marnat Gaultier , Blanc Raphaël , Desal Hubert , Bourcier Romain , Sibon Igor , Lapergue Bertrand ,   on behalf of the ETIS (Endovascular Treatment in Ischemic Stroke) Investigators Group*, Piotin Michel , Blanc Raphaël , Redjem Hocine , Escalard Simon , Desilles Jean-Philippe , Redjem Hocine , Ciccio Gabriele , Smajda Stanislas , Mazighi Mikaël , Fahed Robert , Obadia Mikael , Sabben Candice , Corabianu Ovide , de Broucker Thomas , Smadja Didier , Alamowitch Sonia , Ille Olivier , Manchon Eric , Garcia Pierre-Yves , Taylor Guillaume , Maacha Malek Ben , Wang Adrien , Evrard Serge , Tchikviladze Maya , Afanasiev Vadim , Ajili Nadia , Sensenbrenner Bénédicte , Lapergue Bertrand , Coskun Oguzhan , Consoli Arturo , Di Maria Federico , Rodesch Georges , Del Sette Bruno , Russo Riccardo , Mizutani Katsuhiro , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Nighoghossian Norbert , Riva Roberto , Eker Omer , Turjman Francis , Derex Laurent , Cho Tae-Hee , Mechtouff Laura , Lukaszewicz Anne Claire , Philippeau Frédéric , Cakmak Serkan , Blanc-Lasserre Karine , Vallet Anne-Evelyne , Marnat Gaultier , Gariel Florent , Barreau Xavier , Berge Jérôme , Veunac Louis , Menegon Patrice , Sibon Igor , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Bourcier Romain , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , L’allinec Vincent , Girot Jean-Baptiste , Desal Hubert , de Gaalon Solène , Guillon Benoit , Gory Benjamin , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Richard Sébastien , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Bonnerot Mathieu , Riou-Comte Nolwenn , Costa Isabelle , Chatelain Anne , Costalat Vincent , Arquizan Caroline , Dargazanli Cyril , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , et Lucas Corti Isabelle Mourand , Francois Eugene , Vannier Stéphane 
Published: September 2019

Background and Purpose—
Nonagenarians represent a growing stroke population characterized by a higher frailty. Although endovascular therapy (ET) is a cornerstone of the management of acute ischemic stroke related to large vessel occlusion, the benefit of reperfusion among nonagenarians is poorly documented. We aimed to assess the impact of ET-related reperfusion on the functional outcome of reperfusion in this elderly population.

Methods—
A retrospective analysis of clinical and imaging data from all patients aged over 90 included in the ETIS (Endovascular Treatment in Ischemic Stroke) registry between October 2013 and April 2018 was performed. Association between post-ET reperfusion and favorable (modified Rankin Scale [0–2] or equal to prestroke value) and good (modified Rankin Scale [0–3] or equal to prestroke value) outcome were evaluated. Demographic and procedural predictors of functional outcome, including the first-pass effect, were evaluated. Results were adjusted for center, admission National Institutes of Health Stroke Scale, and use of intravenous thrombolysis.

Results—
Among the 124 nonagenarians treated with ET, those with successful reperfusion had the lowest 90-day modified Rankin Scale (odds ratio, 3.26; 95% CI, 1.04–10.25). Only patients with successful reperfusion after the first pass (n=53, 56.7%) had a reduced 90-day mortality (odds ratio, 0.15; 95% CI, 0.05–0.45) and an increased rate of good outcome (odds ratio, 4.55; 95% CI, 1.38–15.03). No increase in the rate of intracranial hemorrhage was observed among patients successfully reperfused.

Conclusions—
Successful reperfusion improves the functional outcome of nonagenarians who should not be excluded from ET. The first-pass effect should be considered in the procedural management of this frail population.