Mechanical thrombectomy in nonagenarians with acute ischemic stroke
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Mechanical thrombectomy in nonagenarians with acute ischemic stroke. / Meyer, Lukas; Alexandrou, Maria; Leischner, Hannes; Flottmann, Fabian; Deb-Chatterji, Milani; Abdullayev, Nuran; Maus, Volker; Politi, Maria; Roth, Christian; Kastrup, Andreas; Thomalla, Goetz; Mpotsaris, Anastasios; Fiehler, Jens; Papanagiotou, Panagiotis.
in: J NEUROINTERV SURG, Jahrgang 11, Nr. 11, 11.2019, S. 1091-1094.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Mechanical thrombectomy in nonagenarians with acute ischemic stroke
AU - Meyer, Lukas
AU - Alexandrou, Maria
AU - Leischner, Hannes
AU - Flottmann, Fabian
AU - Deb-Chatterji, Milani
AU - Abdullayev, Nuran
AU - Maus, Volker
AU - Politi, Maria
AU - Roth, Christian
AU - Kastrup, Andreas
AU - Thomalla, Goetz
AU - Mpotsaris, Anastasios
AU - Fiehler, Jens
AU - Papanagiotou, Panagiotis
N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/11
Y1 - 2019/11
N2 - 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.
AB - 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.
KW - Journal Article
U2 - 10.1136/neurintsurg-2019-014785
DO - 10.1136/neurintsurg-2019-014785
M3 - SCORING: Journal article
C2 - 31030188
VL - 11
SP - 1091
EP - 1094
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 11
ER -