Abstract TP390: Clinical Characteristics and Outcomes in Nonagenarian and Centenarian Patients With Acute Cerebrovascular Syndrome

Abstract

Background and Purpose: The number of elderly patients with acute cerebrovascular syndrome (ACVS) is increasing. The management of ACVS is difficult especially in very elderly patients such as nonagenarians and centenarians. Therefore, we aimed to clarify the clinical characteristics, treatments, and complications of these patients. Methods: We enrolled 80 patients aged over 90 in a group of 1,420 patients with ACVS who were admitted to our hospital between July 2013 and June 2018. We assessed clinical data and conducted brain MRI/MRA scans, carotid ultrasonograms, echocardiograms, 24hr Holter electrocardiograms and chest-abdominal CT scans to evaluate the severity of atherosclerotic change, stroke subtype, and cardiovascular status in these patients. We categorized them as follows: atherothrombotic brain embolism (ATBE: n=11, 14%), atherothrombotic brain infarction (ATBI: n=9, 11%), cardioembolic infarction (CEI: n=25, n=31%), lacunar infarction (LI: n=15, 19%), transient ischemic attack (TIA: n=6, 8%), and embolic stroke of undetermined source (ESUS: n=14, 18%). Results: Patient age was 92±3 years and 19% were male. Median baseline NIHSS was 9 and median baseline modify Rankin Scale (mRS) was 3. The brain natriuretic peptide (BNP) level was significantly higher in the CEI group (358±206pg/ml) compared to the ATBI group (104±48pg/ml, p<0.001), the ESUS group (130±82pg/ml, p<0.001), the LI group (85±42pg/ml, p<0.001), and the ATBE group (62±49pg/ml, p<0.001). The D-dimer level was correlated to the baseline NIHSS (r=0.44, p<0.01). There were no significant differences of D-dimer level among the stroke subgroups. Anticoagulation for the initial therapy was done in 62 patients (77%) including 2 patients who received thrombolysis. Major complications were aspiration pneumonia (11%), urinary tract infection (10%), bleeding in other organs (6%), and congestive heart failure (5%). The median mRS at discharge was 4 and in-hospital mortality rate was 3.8%. Conclusion: The BNP level was useful to identify the CEI group. Although the ACVS treatment of nonagenarians and centenarians are thought to be high risk for bleeding, the clinical and neurological outcomes were acceptable despite many complications.