Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians.

Age Factors Aged, 80 and over Belgium Brain Ischemia / diagnosis Canada Databases, Factual Endovascular Procedures / adverse effects Female Humans Male Recovery of Function Retrospective Studies Risk Assessment Risk Factors Stroke / diagnosis Switzerland Time Factors Treatment Outcome

Acute ischemic stroke clinical outcome elderly endovascular treatment nonagenarians

Journal

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

ISSN: 1532-8511

Titre abrégé: J Stroke Cerebrovasc Dis

Pays: United States

ID NLM: 9111633

Informations de publication

Date de publication:
Aug 2020

Historique:

received: 22 10 2019

revised: 04 03 2020

accepted: 14 03 2020

entrez: 22 7 2020

pubmed: 22 7 2020

medline: 28 10 2020

Statut: ppublish

Résumé

With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly. Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality. Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days. Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.

Sections du résumé

BACKGROUND BACKGROUND

With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly.

METHODS METHODS

Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality.

RESULTS RESULTS

Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days.

CONCLUSIONS CONCLUSIONS

Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.

Identifiants

DOI: 10.1016/j.jstrokecerebrovasdis.2020.104817 PMID: 32689620

pubmed: 32689620

pii: S1052-3057(20)30201-9

doi: 10.1016/j.jstrokecerebrovasdis.2020.104817

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

104817

Informations de copyright

Déclaration de conflit d'intérêts

Disclosures No conflicts of interests to declare: HJ, NS, FO, DT, DBS, VG, GJ, KJ, PA, GP, HF, DT, DJ, LR, CSA, HS, YL, BI, VM, VDZT, MA, PH, OC, KF, VPA. VG is a consultant for Medtronic and Bayer and has received speaker fees from Bayer, Pfizer, AMGEN and travel fees from BI. AT is a consultant for Ablynx, Amnis Therapeutics, Anaconda, Cerenovus-Neuravi, Medtronic and Rapid Medical.MP has received within the last 2 years through his institution research grants from the Swiss Heart Foundation and BMS; speaker fees from Boehringer-Ingelheim, Medtronic, and Amgen; consulting fees from Medtronic and Amgen, and honoraria from scientific advisory boards from Boehringer-Ingelheim, Pfizer and BMS. All this support is used for stroke education and research.