Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

Abstract

Purpose: Endovascular therapy for emergent large vessel occlusion has been established as the standard approach for acute ischaemic stroke. However, the effectiveness and safety of endovascular therapy in the very elderly population has not been proved. Objective: To determine the safety and effectiveness of endovascular therapy in octogenarians and nonagenarians. Methods: We retrospectively reviewed all patients who underwent endovascular therapy at two stroke centres between April 2012 and July 2018. Functional outcome was assessed using the modified Rankin scale at 90 days after stroke or at discharge. A favourable outcome was defined as a modified Rankin scale score of 0–2 or not worsening of the modified Rankin scale score before stroke. Outcome was compared between younger patients (aged 46–79 years, n = 40) and octogenarians and nonagenarians (aged 80–97 years, n = 19). Results: Octogenarian and nonagenarian patients had pre-stroke functional deficit (modified Rankin scale score >1) more frequently than younger patients (57.9% vs. 20.0%, respectively, P = 0.0059). No difference was observed between very elderly and younger patients in the rate of successful reperfusion (89.5% vs. 67.5%, respectively, P = 0.11), favourable functional outcome (47.4% vs. 45.0%, respectively, P = 1.00) and mortality (21.1% vs. 27.5%, respectively, P = 1.00). On multiple regression analysis, successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were independent predictors of favourable outcome ( P = 0.0003, 0.015 and 0.028, respectively). Conclusions: Successful reperfusion, concomitant use of intravenous thrombolysis, and out-of-hospital onset were clinical predictors of favourable outcome. However, we did not observe an age-dependent effect of clinical outcome after endovascular therapy.

Recanalization Treatment of Acute Ischemic Stroke Caused by Large-Artery Occlusion in the Elderly: A Comparative Analysis of “the Elderly” and “the Very Elderly”

“…Yasuhiro et al proposed that age should not be used as a criterion to exclude elderly patients. They believe that improving recanalization techniques could elevate the success rate of treatment in older patients, but there is still no uniform standard on how to improve the technology [ 18 ].…”

The CHA2DS2-VASc risk score predicts futile recanalization after endovascular treatment in patients with acute ischemic stroke

“…Previous studies have shown that elderly patients with AIS who undergo EVT achieve equally remarkable recanalization rates to those of younger patients. 21,22 Despite comparable recanalization rates, elderly patients may experience worse clinical outcomes after EVT than younger patients. 23 Presence of more comorbidities, impaired collateral circulation, more frequent microvascular pathology, and reduced neurological reserve secondary to agerelated neuronal loss may explain poorer clinical outcomes in elderly patients after EVT.…”

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

“…Many single-center retrospective studies have shown the technical feasibility of MT in the elderly, good recanalization rates, but low rates of good clinical outcomes. 25 30 Some studies (including one that combines octogenarians and nonagenarians), 31 show comparable clinical outcomes to those of younger patients. 32 33 A few meta-analyses have shown poor outcomes in comparison with those for younger patients.…”