Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort
Department of Neurology; Department of Radiology; Department of Psychiatry
Cardiovascular Diseases | Geriatrics | Nervous System Diseases | Neurology | Radiology | Surgery | Surgical Procedures, Operative
BACKGROUND: Recent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion.
OBJECTIVE: To determine the effectiveness of EVT in nonagenarians, for whom data are limited.
METHODS: We retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18-89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed.
RESULTS: Age > /=90 years was associated with a poor (mRS > 2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p < 0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome.
CONCLUSIONS: Nonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.
Angiography, Intervention, Stroke, Thrombectomy
DOI of Published Version
J Neurointerv Surg. 2017 Aug;9(8):727-731. doi: 10.1136/neurintsurg-2016-012427. Epub 2016 Jul 11. Link to article on publisher's site
Journal of neurointerventional surgery
Khan, Muhib A.; Baird, Grayson L.; Miller, David; Patel, Anand; Tsekhan, Shawn; Yaghi, Shadi; Puri, Ajit S.; Jayaraman, Mahesh; Henninger, Nils; and Silver, Brian, "Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort" (2017). Radiology Publications and Presentations. 390.