Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106699. doi: 10.1016/j.jstrokecerebrovasdis.2022.106699. Epub 2022 Aug 30.
The use of endovascular thrombectomy (EVT) has dramatically increased in recent years. However, most existing studies used an upper age limit of 80 and data regarding the safety and efficacy of EVT among nonagenarians is still lacking.
767 consecutive patients undergoing EVT for large vessel occlusion (LVO) in three participating centers were recruited into a prospective ongoing database. Demographic, clinical and imaging characteristics were documented. Statistical analysis was done to evaluate EVT outcome among nonagenarians compared to younger patients.
The current analysis included 41 (5.4%) patients older than 90 years. Compared to younger patients, nonagenarians were more often female (78% versus 50.3%, p ≤ 0.001), had worse baseline mRS scores (2 [0-3] versus 0 [0-2], p < 0.001), higher rates of hypertension and hyperlipidemia and a higher admission NIHSS (20 [14-23] versus 16 [11-20], p < 0.001). No differences were found between groups regarding the involved vessel, stroke etiology, time from symptoms to door or symptoms to EVT, successful recanalization rates and hemorrhagic transformation rates. Nonagenarians had worse mRS at 90 days (5 [3-6] versus 3 [2-5], p = 0.001), similar discharge NIHSS (5 [1-11] versus 4 [1-11], p = 0.78) and higher mortality rates (36.6% versus 15.8%, p < 0.001). All nonagenarians with baseline mRS 4 have died within 90 days. 36.4% of nonagenarian patients with baseline MRS of 3 or less had favorable outcome.
This study demonstrates that nonagenarian stroke patients with baseline mRS of 3 or less benefit from EVT with no significant difference in the rate of favorable outcome compared to octogenarians.
近年来，血管内血栓切除术（EVT）的应用显著增加。然而，大多数现有研究使用的年龄上限为 80 岁，关于 90 岁以上患者行 EVT 的安全性和有效性的数据仍然缺乏。
在三个参与中心，对 767 例接受大血管闭塞（LVO）EVT 的连续患者进行前瞻性登记，记录其人口统计学、临床和影像学特征。统计分析用于评估 90 岁以上患者与年轻患者的 EVT 结局。
目前的分析包括 41 例（5.4%）年龄大于 90 岁的患者。与年轻患者相比，90 岁以上患者女性比例更高（78%对 50.3%，p≤0.001），基线 mRS 评分更差（2 [0-3]对 0 [0-2]，p<0.001），高血压和高脂血症的发生率更高，入院 NIHSS 评分更高（20 [14-23]对 16 [11-20]，p<0.001）。两组之间在受累血管、卒中病因、从症状到门的时间或从症状到 EVT 的时间、再通率和出血转化率方面无差异。90 天时，90 岁以上患者 mRS 评分更差（5 [3-6]对 3 [2-5]，p=0.001），出院 NIHSS 评分相似（5 [1-11]对 4 [1-11]，p=0.78），死亡率更高（36.6%对 15.8%，p<0.001）。所有基线 mRS 4 的 90 岁以上患者均在 90 天内死亡。36.4%的基线 mRS 为 3 或更低的 90 岁以上患者预后良好。
本研究表明，基线 mRS 为 3 或更低的 90 岁以上卒中患者从 EVT 中获益，与 80 岁以上患者相比，良好预后的发生率无显著差异。
