Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Department of Neurology, University Hospital in Krakow, Krakow, Poland.
Neurol Neurochir Pol. 2024;58(4):429-436. doi: 10.5603/pjnns.99386. Epub 2024 Jul 12.
To assess outcomes of mechanical thrombectomy (MT) in nonagenarians suffering from acute ischaemic stroke (AIS) in a 1-year follow-up.
Age is a factor associated with both the occurrence of AIS and a poorer prognosis. As the population ages, the prevalence of AIS among the very old (90 and older) is expected to rise. Data on long-term outcomes of MT, being the optimal treatment of AIS caused by large vessel occlusions, is scarce in the population of nonagenarians.
We analysed all AIS patients treated with MT in a single Comprehensive Stroke Centre. We compared two subgroups: nonagenarians (people aged 90-99) and controls ( < 90 years) in terms of cardiovascular risk factors profile, stroke severity, treatment course, presence of in-hospital complications, and outcomes (mortality and good functional outcome defined as modified Rankin Scale ≤ 2) at discharge and at 90- and 365-day follow-ups.
Nonagenarians were more commonly female and suffering from atrial fibrillation. They more often developed urinary tract infection during hospitalisation. Stroke severity, treatment course and in-hospital outcomes were comparable between the groups. Nonagenarians had non-significantly higher 90-day and 365-day mortality, and a significantly lower rate of good functional outcomes after 90 days (25.0% vs 57.7%, p = 0.011) and 365 days (31.5% vs 61.0%, p = 0.020).
Despite worse outcomes than in younger patients, 25% of nonagenarians were functionally independent three months after MT, and almost one in three of them were so a year after the procedure, thereby showing the benefits of the treatment in this group.
评估 90 岁以上急性缺血性脑卒中（AIS）患者接受机械取栓术（MT）的 1 年随访结果。
年龄是 AIS 发生和预后较差的一个相关因素。随着人口老龄化，非常高龄（90 岁及以上）人群中 AIS 的发病率预计将会上升。对于 MT 这一大血管闭塞性 AIS 的最佳治疗方法，在 90 岁以上人群中，关于其长期结果的数据非常有限。
我们分析了单一综合性卒中中心采用 MT 治疗的所有 AIS 患者。我们比较了两个亚组：90 岁及以上的非 90 岁组（<90 岁），比较内容包括心血管危险因素谱、卒中严重程度、治疗过程、院内并发症以及出院时、90 天和 365 天随访时的结局（死亡率和改良 Rankin 量表评分≤2 的良好功能结局）。
非 90 岁组女性更多见，且更常合并心房颤动。非 90 岁组患者住院期间更常发生尿路感染。两组患者的卒中严重程度、治疗过程和院内结局相似。非 90 岁组患者的 90 天和 365 天死亡率非显著更高，且 90 天（25.0%比 57.7%，p = 0.011）和 365 天（31.5%比 61.0%，p = 0.020）的良好功能结局率显著更低。
尽管非 90 岁组患者的结局不如年轻患者，但 MT 治疗后 3 个月仍有 25%的患者实现了功能独立，且有近 1/3 的患者在治疗 1 年后仍保持如此状态，提示治疗对该人群有益。
