Mechanical Thrombectomy in Nonagenarians: A Propensity Score Matched Analysis

Area of Science:

• Neurology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Limited data exists on the outcomes of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in nonagenarians.
• This study compares procedural and discharge outcomes of MT in nonagenarians versus younger patients.

Purpose of the Study:

• To compare procedural and discharge outcomes of MT for AIS in nonagenarians versus a younger cohort (≤69 years).
• To evaluate the efficacy and safety of MT in the oldest patient demographic.

Main Methods:

• Propensity score-matching was used to compare nonagenarians (≥90 years) with patients aged ≤69 who underwent MT for AIS.
• Exclusion of patients aged 70-89 allowed for a direct comparison with a younger cohort representative of seminal MT trials.
• Good discharge disposition was defined as discharge to home or acute rehabilitation.

Main Results:

• Successful recanalization (mTICI≥2b) was achieved in 90% of both nonagenarians and the younger cohort.
• Revascularization and door-to-puncture times were similar between the groups.
• Symptomatic intracranial hemorrhage and in-hospital death rates trended lower in nonagenarians.
• Good discharge disposition was observed in 44% of nonagenarians versus 51% of the younger cohort (P=0.496).

Conclusions:

• Mechanical thrombectomy in nonagenarians with AIS demonstrates high rates of successful recanalization.
• Outcomes, including discharge disposition, are comparable to a significantly younger patient cohort (≤69 years).
• MT is a viable treatment option for select nonagenarian patients with AIS.