Article Text

Download PDFPDF
Original research
Outcomes of endovascular thrombectomy in patients selected by computed tomography perfusion imaging – a matched cohort study comparing nonagenarians to younger patients
  1. Rahul Rahangdale1,2,
  2. Christopher Todd Hackett1,
  3. Russell Cerejo3,
  4. Nicholas M Fuller1,4,
  5. Konark Malhotra1,
  6. Richard Williamson3,
  7. Terry Hentosz1,
  8. Ashis H Tayal1,
  9. Sandeep S Rana1
  1. 1Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  2. 2Neurology, St John Medical Center, Tulsa, Oklahoma, USA
  3. 3Cerebrovascular Center, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
  4. 4Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
  1. Correspondence to Dr Sandeep S Rana, Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA; Sandeep.RANA{at}ahn.org

Abstract

Background Endovascular thrombectomy (EVT) is efficacious for appropriately selected patients with large vessel occlusions (LVO) up to 24 hours from symptom onset. There is limited information on outcomes of nonagenarians, selected with computed tomography perfusion (CTP) imaging.

Methods We retrospectively analyzed data from a large academic hospital between December 2017 and October 2019. Patients receiving EVT for anterior circulation LVO were stratified into nonagenarian (≥90 years) and younger (<90 years) groups. We performed propensity score matching on 18 covariates. In the matched cohort we compared: primary outcome of inpatient mortality and secondary outcomes of successful reperfusion (TICI ≥2B), symptomatic intracranial hemorrhage (sICH), and functional independence. Subgroup analysis compared CTP predicted core volumes in nonagenarians with outcomes.

Results Overall, 214 consecutive patients (26 nonagenarians, 188 younger) underwent EVT. Nonagenarians were aged 92.8±2.9 years and younger patients were 74.5±13.5 years. Mortality rate was significantly greater in nonagenarians compared with younger patients (43.5% vs 10.4%, OR 9.33, 95% CI 2.88 to 47.97, P<0.0001) and a greater proportion of nonagenarians developed sICH (13.0% vs 3.0%, OR 6.00, 95% CI 1.34 to 55.20, P=0.02). There were no significant differences for successful reperfusion (P=1.00) or functional independence (P=0.75). Nonagenarians selected with smaller ischemic core volumes had decreased mortality rates (P=0.045).

Conclusions Nonagenarians were noted to have greater mortality and sICH rates following EVT compared with matched younger patients, which may be ameliorated by selecting patients with smaller CTP core volumes. Nonagenarians undergoing EVT had similar rates of successful reperfusion and functional independence compared with the younger cohort.

  • stroke
  • CT perfusion
  • thrombectomy

Data availability statement

Data that support the findings of this study are available from the corresponding author upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data that support the findings of this study are available from the corresponding author upon reasonable request.

View Full Text

Footnotes

  • Contributors RR, CTH, and NMF collected data. RR, CTH, RC, and SSR designed the study. CTH analyzed the data. RR, CTH, RC, KM, RW, TH, AHT, and SSR drafted the manuscript and interpreted data. RR, CTH, RC, KM, RW, TH, AHT, and SSR critically reviewed and edited the manuscript.

  • 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 RC is a member of the iSchemaView advisory board. All other authors declare no conflicts of interest.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.