Daniel A Tonetti1, Bradley A Gross2, Shashvat M Desai3, Ashutosh P Jadhav3, Brian T Jankowitz4, Tudor G Jovin3. 1. UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 2. UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: Grossb2@upmc.edu. 3. UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 4. UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Abstract
BACKGROUND: Although elderly patients have generally worse outcomes after acute ischemic stroke, they may derive significant incremental benefit from thrombectomy as compared with medical management. Although several case series for octogenarians have been reported, data for nonagenarians are scarce. METHODS: A prospectively maintained institutional mechanical thrombectomy database was reviewed for nonagenarians who underwent thrombectomy between January 2013 and July 2017. Patient demographic data and clinical history data were extracted, and clinical and radiographic outcomes were assessed. Univariate analysis was used to determine correlation between treatment and radiographic data and outcome. RESULTS: During the study period, 30 patients ≥90 years old underwent mechanical thrombectomy. Median National Institutes of Health Stroke Scale score on presentation was 20. Successful reperfusion (Thrombolysis In Cerebral Infarction 2b/3) was achieved in 27 patients (90%). One patient (3%) was discharged to home, and 9 patients (30%) were discharged to a rehabilitation facility. The 90-day mortality was 70%. Six patients (21%) returned to living at home. All 6 patients had successful reperfusion after the procedure; average infarct burden on postthrombectomy neuroimaging was 1.5 cm3, and infarct volume was <7 cm3 in all cases. Final infarct volume of <10 cm3 was a strong predictor of whether a patient returned to live at home (P = 0.002), with a trend toward better outcome as assessed by modified Rankin Scale (P = 0.076). CONCLUSIONS: Large vessel thrombectomy in nonagenarians is safe and offers patients a chance at returning to functional baseline. All patients returning home in our cohort had successful recanalization and minimal stroke burden after thrombectomy.
BACKGROUND: Although elderly patients have generally worse outcomes after acute ischemic stroke, they may derive significant incremental benefit from thrombectomy as compared with medical management. Although several case series for octogenarians have been reported, data for nonagenarians are scarce. METHODS: A prospectively maintained institutional mechanical thrombectomy database was reviewed for nonagenarians who underwent thrombectomy between January 2013 and July 2017. Patient demographic data and clinical history data were extracted, and clinical and radiographic outcomes were assessed. Univariate analysis was used to determine correlation between treatment and radiographic data and outcome. RESULTS: During the study period, 30 patients ≥90 years old underwent mechanical thrombectomy. Median National Institutes of Health Stroke Scale score on presentation was 20. Successful reperfusion (Thrombolysis In Cerebral Infarction 2b/3) was achieved in 27 patients (90%). One patient (3%) was discharged to home, and 9 patients (30%) were discharged to a rehabilitation facility. The 90-day mortality was 70%. Six patients (21%) returned to living at home. All 6 patients had successful reperfusion after the procedure; average infarct burden on postthrombectomy neuroimaging was 1.5 cm3, and infarct volume was <7 cm3 in all cases. Final infarct volume of <10 cm3 was a strong predictor of whether a patient returned to live at home (P = 0.002), with a trend toward better outcome as assessed by modified Rankin Scale (P = 0.076). CONCLUSIONS: Large vessel thrombectomy in nonagenarians is safe and offers patients a chance at returning to functional baseline. All patients returning home in our cohort had successful recanalization and minimal stroke burden after thrombectomy.