Predictors of Outcome After Mechanical Thrombectomy in Stroke Patients Aged ≥85 Years. (9th January 2022)

• Record Type: Journal Article
• Authors: Derex, Laurent; Haesebaert, Julie; Odier, Céline; Alesefir, Walid; Berthezène, Yves; Buisson, Marielle; Daneault, Nicole; Deschaintre, Yan; Eker, Omer Faruk; Gioia, Laura; Iancu, Dana; Jacquin, Grégory; Karkri, Fatine; Lapierre, Marlène; Nighoghossian, Norbert; Raymond, Jean; Roy, Daniel; Stapf, Christian; Weill, Alain; Poppe, Alexandre Y.
• Is Part Of: Canadian journal of neurological sciences. Volume 49:Number 1(2022)
• Page Start: 49
• Page End: 54
• Publication Date: 2022-01-09
• Subjects: Elderly -- Ischemic stroke -- Mechanical thrombectomy -- Reperfusion; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2021.37
• Languages: English
• ISSNs: 0317-1671

Abstract

ABSTRACT: Background: The effectiveness of mechanical thrombectomy (MT) in elderly stroke patients remains debated. We aimed to describe outcomes and their predictors in a cohort of patients aged ≥ 85 years treated with MT. Methods: Data from consecutive patients aged ≥ 85 years undergoing MT at two stroke centers between January 2016 and November 2019 were reviewed. Admission National Institutes of Health Stroke Scale (NIHSS), pre-stroke, and 3-month modified Rankin scale (mRS) were collected. Successful recanalization was defined as modified thrombolysis in cerebral ischemia score ≥ 2b. Good outcome was defined as mRS 0–3 or equal to pre-stroke mRS at 3 months. Results: Of 151 included patients, successful recanalization was achieved in 74.2%. At 3 months, 44.7% of patients had a good outcome and 39% had died. Any intracranial hemorrhage (ICH) and symptomatic ICH occurred in 20.3% and 3.6%, respectively. Logistic regression analysis identified lower pre-stroke mRS score (adjusted odds ratio [aOR], 0.52; 95% CI, 0.36–0.76), lower admission NIHSS score (aOR, 0.90; 95% CI, 0.83–0.97), successful recanalization (aOR, 3.65; 95% CI, 1.32–10.09), and absence of ICH on follow-up imaging (aOR, 0.42; 95% CI, 0.08–0.75), to be independent predictors of good outcome. Patients with successful recanalization had a higher proportion of good outcome (45.3% vs 34.3%, p = 0.013) and lower mortality at 3 months (35.8% vs 48.6%, p = 0.006) compared to patients with unsuccessful recanalization. Conclusions: Among patients aged ≥ 85 years, successful recanalization with MT is relatively common and associated with better 3-month outcome and lower mortality than failed recanalization. Attempting to achieve recanalization in elderly patients using MT appears reasonable.