Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years

• Published in: Clinical neurology and neurosurgery 2021-01, Vol.200, p.106354-106354, Article 106354
• Main Authors: Sojka, Michał, Szmygin, Maciej, Pyra, Krzysztof, Tarkowski, Piotr, Luchowski, Piotr, Wojczal, Joanna, Drelich-Zbroja, Anna, Jargiełło, Tomasz
• Format: Article
• Language: English
• Subjects: Age; Carotid arteries; Catheters; Clinical outcomes; Clinical results; Hematoma; Hemorrhage; Ischemia; Ischemic stroke; Mechanical thrombectomy; Medical imaging; Mortality; Neurology; Nonagenarians; Patients; Statistical analysis; Stroke; Veins & arteries
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106354

•Mechanical thrombectomy in very elderly patients is challenging due to age-related impairment of vascular structures.•Rate of procedural complication is not significantly higher compared to younger patients.•Despite high mortality rate and moderate overall outcome some nonagenarians do benefit greatly from MT.•Long-term outcome is predicted by stroke severity (baseline NIHSS, occluded vessel) and hospital arrival time. Mechanical thrombectomy (MT) has established its role as a first-line treatment of acute ischemic stroke due to large vessel occlusions (LVO). However, patients older than 85 or even 80 years of age are commonly excluded from large randomized controlled stroke studies as this group was found to be associated with significantly poorer clinical outcome and increased mortality compared to younger patients. The aim of this study was to evaluate clinical and procedural factors associated with clinical outcome and mortality among nonagenarians with acute ischemic stroke treated with mechanical thrombectomy. This retrospective, single-center study was conducted on 38 patients with LVO treated with MT. Clinical features including baseline results, radiological imaging, procedural details and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS) and after 3 months (mRS). The rate of successful recanalization (TICI ≥2b) was 84.2 % (32/38). Symptomatic intracranial hemorrhage (sICH) was observed in 3 (7.9 %) patients. After 90 days, the mortality rate was 47.4 %. Favorable clinical outcome (mRs 0−2) was regained in 28.9 % of the patients (11/38). Poor clinical outcome (mRs