Thrombectomy for acute ischemic stroke in nonagenarians compared with octogenarians

Area of Science:

• Neurology
• Interventional Neurology
• Geriatric Stroke

Background:

• Endovascular thrombectomy (EVT) improves outcomes in acute ischemic stroke (AIS) with large vessel occlusion (LVO).
• Elderly patients are underrepresented in EVT trials, leaving efficacy in the oldest uncertain.
• Nonagenarians (90-99 years) represent a particularly understudied group.

Purpose of the Study:

• To evaluate the efficacy and safety of EVT in nonagenarian patients with AIS-LVO.
• To compare outcomes between nonagenarians and octogenarians (80-89 years) undergoing EVT.

Main Methods:

• Retrospective single-center cohort study of patients aged 80-99 with AIS-LVO.
• Patients stratified into octogenarian (80-89) and nonagenarian (90-99) groups.
• Primary outcome: modified Rankin Scale (mRS) at 90 days; secondary outcomes: functional independence, revascularization, symptomatic intracranial hemorrhage (ICH), and mortality.

Main Results:

• 108 patients included: 79 octogenarians, 29 nonagenarians.
• Successful revascularization (TICI 2b-3) achieved in 79% of both groups.
• Nonagenarians had higher rates of symptomatic ICH (21.4% vs 6.4%, p=0.03) and a trend towards higher 90-day mortality (63% vs 40.9%, p=0.07).
• Functional independence (mRS ≤2) was similar between groups (12.5% nonagenarians vs 19.7% octogenarians, p=0.54).

Conclusions:

• Nonagenarians undergoing EVT for AIS-LVO may face a higher risk of symptomatic ICH.
• While trends suggest worse functional outcomes and higher mortality in nonagenarians, these did not reach statistical significance in this study.
• Further research is needed to confirm these findings in larger cohorts.