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Ischemic Stroke
Original research
Mechanical thrombectomy in nonagenarians with acute ischemic stroke
  1. Lukas Meyer1,2,
  2. Maria Alexandrou2,
  3. Hannes Leischner1,
  4. Fabian Flottmann1,
  5. Milani Deb-Chatterji3,
  6. Nuran Abdullayev4,
  7. Volker Maus5,
  8. Maria Politi2,
  9. Christian Roth2,
  10. Andreas Kastrup6,
  11. Goetz Thomalla3,
  12. Anastasios Mpotsaris7,
  13. Jens Fiehler1,
  14. Panagiotis Papanagiotou2
  1. 1 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte GmbH, Bremen, Germany
  3. 3 Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  4. 4 Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
  5. 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center of Goettingen, Göttingen, Germany
  6. 6 Department of Neurology, Klinikum Bremen-Mitte GmbH, Bremen, Germany
  7. 7 Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
  1. Correspondence to Professor Panagiotis Papanagiotou, Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, 28205 Bremen, Germany; papanagiotou{at}me.com

Abstract

Background Mechanical thrombectomy (MT) is a safe and effective therapy for ischemic stroke. Nevertheless, very elderly patients aged ≥90 years were either excluded or under-represented in previous trials. It remains uncertain whether MT is warranted for this population or whether there should be an upper age limit.

Methods We retrospectively reviewed 79 patients with stroke aged ≥90 years from three neurointerventional centers who underwent MT between 2013 and 2017. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 90-day follow-up. Successful recanalization was graded by Thrombolysis in Cerebral Infarction Scale (TICI) ≥2 b. Feasibility and safety assessments included unsuccessful recanalization attempts (TICI 0), time from groin puncture to recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events.

Results Only occlusions within the anterior circulation were included. Median time from groin puncture to recanalization was 39 min (IQR 25–57 min). The rate of successful recanalization (TICI ≥2 b) was 69.6% (55/79). Good functional outcome (mRS ≤2) at 90 days was observed in 16% (12/75) of patients. In-hospital mortality was 29.1% (23/79) and increased significantly at 90 days (46.7%, 35/75; p<0.001). sICH occurred in 5.1% (4/79) of patients. No independent predictor for good functional outcome (mRS ≤2) at 90 days was identified through logistic regression analysis.

Conclusion MT in nonagenarians leads to high mortality rates and less frequently good functional outcome compared with younger patient cohorts in previous large randomized trials. However, MT appears to be safe and beneficial for a certain number of very elderly patients and therefore should generally not be withheld from nonagenarians.

  • intervention
  • thrombectomy
  • stroke
  • thrombolysis

https://doi.org/10.1136/neurintsurg-2019-014785

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    Footnotes

    • Contributors LM, MA, and PP made substantial contributions to the conception and design of the work. Data acquisition was performed by LM, AM, HL, FF, VM, NA, and MD-C. LM and PP performed the data analysis. Interpretation of the data was done by LM, JF, GT, AM, CR, AK, MP and PP. LM and PP drafted the manuscript and all of the other authors revised it critically for important intellectual content. All authors approved the final version to be published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PP: Consultant for Penumbra. JF: Consultant for Acandis, Boehringer Ingelheim, Codman, Microvention, Sequent, Stryker. Speaker for Bayer Healthcare, Bracco, Covidien/ev3, Penumbra, Philips, Siemens. Grants from Bundesministeriums für Wirtschaft und Energie (BMWi), Bundesministerium für. Bildung und Forschung (BMBF), Deutsche Forschungsgemeinschaft (DFG), European Union (EU), Covidien, Stryker (THRILL study), Microvention (ERASER study), Philips. GT: Received personal fees as consultant/lecturer from Acandis, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, Daichi Sankyo, Stryker, and research grants from Bayer, Federal Ministry for Economic Affairs and Energy (BMWi), Corona-Foundation, German Research Foundation (DFG), Else Kröner-Fresenius Foundation, European Union (Horizon 2020), German Innovation Fund. AM: Consultant for Stryker, Penumbra, Perflow, Phenix. All other authors declared no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.