Ghent University, Department of neurology, Gent, Belgium.
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104817. doi: 10.1016/j.jstrokecerebrovasdis.2020.104817. Epub 2020 Apr 25.
With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly.
Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality.
Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%. Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days.
Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.
随着急性脑卒中患者住院年龄的增加，需要更多关于高龄患者血管内治疗（EVT）的适应证、并发症和结局的数据。
这是一项回顾性观察性研究，数据来自比利时、瑞士、加拿大综合性卒中中心和瑞典 EVT 国家数据库。所有年龄大于或等于 90 岁并接受 EVT±静脉溶栓（IVT）预处理的急性缺血性脑卒中患者均符合条件。安全性评估包括围手术期并发症、出血性转化或其他不良事件（<7 天）的发生情况。疗效和结局测量指标包括血管再通成功（改良脑梗死治疗（mTICI）评分≥2b）、临床结局良好（改良 Rankin 评分（mRS）0-2）和 3 个月死亡率。
纳入 112 名 90 岁以上患者（平均年龄 93.3 ± 2.5 岁；76.8%为女性；预处理前 mRS≤2 占 69.4%）。54.7%的患者接受了 IVT 预处理。74.6%的患者达到了血管再通成功（mTICI≥2b）。16.4%的患者临床结局良好（mRS≤2），3 个月死亡率为 62.3%。多变量逻辑回归分析显示，年龄较小（优势比 [OR] 2.99；1.29-6.95；P=0.011）和较低的预处理前 mRS（OR 13.46；2.32-78.30；P=0.004）是 90 天临床结局良好的显著预测因素。
我们对 90 岁以上患者 EVT 的观察性研究表明，需要仔细选择患者。尽管再通率可接受，但相当一部分 90 岁以上患者的临床结局不良，死亡率较高。高发病前残疾（mRS）和高龄预测不良结局。治疗决策应根据具体情况进行评估，考虑到良好结局的机会有限和高死亡率的风险。
