Outcomes of Large Vessel Occlusion Stroke in Patients Aged ≥90 Years

Abstract

Background and Purpose: Outcomes in patients ≥90 years of age with stroke due to large vessel occlusion were compared between endovascular therapy (EVT) and medical management. Methods: Of 2420 acute ischemic stroke patients with large vessel occlusion in a prospective, multicenter, nationwide registry in Japan, patients aged ≥90 years with occlusion of the internal carotid artery or M1 segment of the middle cerebral artery were included. The primary effectiveness outcome was a favorable outcome at 3 months, defined as achieving a modified Rankin Scale score of 0 to 2 or return to at least the prestroke modified Rankin Scale score at 3 months. Safety outcomes included symptomatic intracranial hemorrhage within 72 hours after onset. Intergroup biases were adjusted by multivariable adjustment with inverse probability of treatment weighting. Results: A total of 150 patients (median age, 92 [interquartile range, 90–94] years; median prestroke modified Rankin Scale score, 2 [interquartile range, 0–4]) were analyzed. EVT was performed in 49 patients (32.7%; mechanical thrombectomy, n=43). The EVT group showed shorter time from onset to hospital arrival ( P =0.03), higher Alberta Stroke Program Early Computed Tomography Score ( P <0.01), and a higher rate of treatment with intravenous thrombolysis ( P <0.01) than the medical management group. The favorable outcome was seen in 28.6% of the EVT group and 6.9% of the medical management group ( P <0.01). EVT was associated with the favorable outcome (adjusted odds ratio, 8.44 [95% CI, 1.88–37.97]). Rates of symptomatic intracranial hemorrhage were similar between the EVT group (0.0%) and the medical management group (3.9%; P =0.30). Conclusions: Patients who underwent EVT showed better functional outcomes than those with medical management without increased symptomatic intracranial hemorrhages. Given proper patient selection, withholding EVT solely on the basis of the age of patients may not offer the best chance of good outcome. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02419794.

Reperfusion therapy for acute ischemic stroke in older people: An observational real‐life study

“…Indeed, if this outcome appears globally bad for older adults and if it suggests that acute reperfusion treatments might be futile in the oldest old, we have here to keep in mind the absence of a control group in our study. In a recent study, 28.6% of the EVT group of patients with AIS aged ≥90 years old achieved an mRS score of 0–2 or returned to at least the prestroke mRS score at 3 months 36 . In a recent meta‐analysis of outcomes following EVT in observational studies using new thrombectomy devices, 30% of the AIS patients >80 achieved mRS 0‐2 at 3 months compared to 52% of patients <80 years ( p < 0.001) 37 .…”

“…In a recent study, 28.6% of the EVT group of patients with AIS aged ≥90 years old achieved an mRS score of 0-2 or returned to at least the prestroke mRS score at 3 months. 36 In a recent metaanalysis of outcomes following EVT in observational studies using new thrombectomy devices, 30% of the AIS patients >80 achieved mRS 0-2 at 3 months compared to 52% of patients <80 years (p < 0.001). 37 These results were better than outcomes of AIS patients not treated with EVT in historical cohort providing further support for EVT in the oldest patients.…”

Prognostic significance of age in patients with acute ischaemic stroke treated with intravenous thrombolysis

“…The same applied to those aged 90 or more years in the context of another type of reperfusion therapy, i.e. endovascular therapy, which did not increase the risk of symptomatic intracranial haemorrhage either [25].…”

Successful Mechanical Thrombectomy for Acute Middle Cerebral Artery Occlusion in a Centenarian

“…Thus, the efficacy of MT in very old patients remains unclear. Recently, one study showed that even in patients aged >90 years, MT improves outcomes [7]. However, poor outcomes with MT have also been reported in patients >90 years of age [16].…”

“…Although clinical trials have proven the efficacy and beneficial therapeutic outcomes of endovascular therapy in patients with large-vessel occlusion (LVO) [1][2][3][4][5], its efficacy in very elderly patients, such as nonagenarians or centenarians, is yet to be established. A study reported that mechanical thrombectomy (MT) does not lead to good outcomes in patients over 80 years of age [6], whereas another stated that MT can improve outcomes in patients over 90 years of age [7]. There are even fewer reports in the literature on centenarians [8][9][10][11].…”