Acute Reperfusion Therapies and Prognosis in Nonagenarian Stroke Patients

Abstract

Introduction: Thrombolysis and endovascular thrombectomy (EVT) are standard treatments after stroke. We previously reported that these therapies benefit stroke patients over 80 years old. Now, we aim to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group. Methods: Nonagenarian stroke patients were identified from our prospective monocentric cohort, which included consecutive patients >80 years old treated with thrombolysis and/or EVT from 2015–2019. Baseline characteristics, treatments and outcomes, as well as complications and mortality were analyzed. Results: 96 nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). 51% had a pre-stroke modified Rankin Score (mRS) ≤2. Cardioembolism was the most common etiology (67.7%). Age was associated with a higher mRS after stroke with a turning point at 90 years old : (90–99 years old: odds ratio (OR)=0.33, 95% confidence interval (95%CI):0.13–0.83, P=0.02) versus (85–89 years old: OR=0.72, 95%CI:0.34–1.50, P=0.38), and (80–84-year-old patients as the reference). In nonagenarians, previous coronary artery disease (OR=8.02, 95%CI:1.66–38.68, P=0.01), initial NIHSS (OR=1.11, 95%CI:1.03–1.19, P=0.01), pre stroke independence (OR=0.25, 95%CI:0.08–0.71, P=0.01) and ‘drip-and-ship’ status (OR=3.35, 95%CI:1.22–9.16, P=0.02) were associated with 3-month mortality. Nonagenarians had more baseline co-morbidities (P=0.003) and lower levels of pre-stroke independence (P=0.002) than octogenarians (n=261). Despite no difference in the use of acute treatments, timelines and rates of successful reperfusion, a good functional status at 3 months was less common in nonagenarians than octogenarians (14.3% versus 34.0%, P<0.001) with a higher mortality (60.2% versus 16.4%, P<0.001). 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage. Conclusions: Age is a crucial factor affecting prognosis after stroke with a turning point at 90 years old. However, age alone should not be a limiting factor for treatment decision. Despite higher mortality and poorer functional prognosis overall, some nonagenarians may benefit from reperfusion therapies