Legris Nicolas, Bicart-See Louise, Ancelet Claire, Venditti-Maillet Laura, Chassin Olivier, Peillet Claire, Sarov-Riviere Mariana, Laine Olga, Vetillard Anne-Laure, Pujol Tom, Brunetti Nicoletta, Dupont Deschamps Caroline, Baudry Elodie, Spelle Laurent, Rouquette Alexandra, Denier Christian
Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Saclay University, Le Kremlin Bicêtre, France.
Neuroradiology, Bicêtre Hospital, AP-HP, Paris Saclay University, Le Kremlin Bicêtre, France.
Gerontology. 2024;70(12):1241-1252. doi: 10.1159/000540872. Epub 2024 Oct 31.
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 aimed to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group.
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 to 2019. Baseline characteristics, treatments, and outcomes, as well as complications and mortality were analyzed.
Ninety-six nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). A total of 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), with 80- to 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 National Institute of Health Stroke Score (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 comorbidities (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% vs. 34.0%, p < 0.001) with a higher mortality (60.2% vs. 16.4%, p < 0.001). A total of 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage.
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.
