Mechanical thrombectomy in stroke in nonagenarians: useful or futile?

Pinto, Mafalda Mendes; Nunes, Ana Paiva; Alves, Marta; Papoila, Ana Luísa; Pamplona, Jaime; Carvalho, Rui A.; Baptista, Mariana; Reis, João Carlos R.; Fragata, Isabel

doi:10.1016/j.jstrokecerebrovasdis.2020.105015

Cited by 10 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The poor outcome among nonagenarians treated with MT was driven largely by the severity of pre-existing functional deficits rather than by age itself. The past study reported in-hospital death of patients ≥90 years old treated with MT as 7-29%, 12,[17][18][19][20] which was similar to our present study (16%). The result suggests that the MT procedures do not directly cause patients death in ≥90-year-old group, but management of post-stroke complications, especially respiratory ones, and pre-existing comorbidities is important.…”

Section: Discussionsupporting

confidence: 91%

“… 16) Another three reports also showed comparable effects of MT between patients ≥90 years old and younger patients. 17 – 19) On the contrary, Khan et al revealed that ≥90-year-old patients had poor functional outcome at 3 months compared with <90-year-old patients. 11) However, the mRS at 3 months was similar in both groups in a stratified analysis according to the pre-stroke mRS.…”

Section: Discussionmentioning

confidence: 99%

“…There are six retrospective studies, including our analysis, investigating the efficacy of MT for patients ≥90 years of age relative to patients <90 years of age. 11,[16][17][18][19] Sussman et al evaluated 108 patients with AIS treated between 2010 and 2018. Twenty-seven percent of the patients was ≥90 years old, and these patients population was similar to our study.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Kawaji

Tomoto

Arakawa

et al. 2021

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Mechanical thrombectomy (MT) is a proven treatment for acute ischemic stroke (AIS). However, the efficacy of this treatment is uncertain for very elderly patients. This study aimed to investigate the safety and effectiveness of MT in 90 years or older patients compared with younger patients. We retrospectively reviewed AIS patients treated with MT between October 2018 and June 2020 in our institution. Patients were divided into two groups: aged ≥90 and <90 years. We compared the following factors: functional outcome at discharge, in-hospital death, successful recanalization, and complications. Multivariate logistic regression analysis for the good functional outcome was performed. In consideration of pre-stroke basic activities of very elderly patients, we defined the good functional outcome as modified Rankin Scale (mRS) 0-3. In all, 66 patients were included, and 19 patients (28%) were ≥90 years old. Pre-stoke mRS was higher in ≥90-year-old patients (p = 0.01). In ≥90-year-old patients, we achieved successful recanalization in 17 patients (90%), and only one patient experienced hemorrhagic complication related with the procedure. The good functional outcome (mRS: 0-3) at discharge were six patients (32%) in ≥90 years old versus 19 patients (40%) in <90 years old (p = 0.6). Three patients died in hospital in each group (16% versus 6%) (p = 0.3). Only the stroke severity was negatively related with the good functional outcome in a multivariate analysis. In conclusion, for ≥90-year-old patients compared with younger patients, MT is an equally feasible therapy. Patients should not be excluded from MT based on age alone.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Kawaji

Tomoto

Arakawa

et al. 2021

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…39 Some data from singlecenter studies also show that MT in nonagenarians is feasible, but with low rates of good outcomes, 40 and a particularly high rate of hemorrhagic complications. 41 Some data from single centers show no difference between octogenarians and nonagenarians 42 or younger patients, 43 and no difference in discharge disposition between younger patients (<69 years) and nonangenarians. 44 There has been one meta-analysis for this topic showing high revascularization rates in nonagenarians with low rates of good clinical outcomes.…”

Section: Standardsmentioning

confidence: 99%

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Al‐Mufti

Schirmer

Starke

et al. 2021

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundThe purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis.MethodsWe performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence.ResultsMT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.

show abstract

“…Recent studies focusing on premorbid independent nonagenarians have reported favourable outcome in up to 39% of such patients [57 ▪ ]. Moreover, three studies have reported similar or even better favourable outcome rates of EVT among nonagenarians compared with octogenarians [57 ▪ ,60,61]. Yet, this may result from a more permissive patient selection of octogenarians compared with nonagenarians and requires further evaluation.…”

Section: Nonagenariansmentioning

confidence: 99%

Current advances in endovascular treatment

Molad

Honig

2023

Current Opinion in Neurology

View full text Add to dashboard Cite

Purpose of reviewEndovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients selection and periprocedural management. Recent findingsRecent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.

show abstract

Mechanical thrombectomy in stroke in nonagenarians: useful or futile?

Cited by 10 publications

References 32 publications

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Feasibility of Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 90 Years or Older Compared to Younger Patients

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Current advances in endovascular treatment

Contact Info

Product

Resources

About