Endovascular Stroke Treatment of Nonagenarians

The purpose of this study was the evaluation of procedural and outcome data of patients 90 years of age or older undergoing endovascular stroke treatment. The authors retrospectively analyzed prospectively collected data of 29 patients (mean age 91.9 years) in whom endovascular stroke treatment was performed between January 2011 and January 2016 (from a cohort of 615 patients). Successful recanalization (TICI % 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2. Despite high mortality rates (approximate to 45%) and moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred. BACKGROUND AND PURPOSE: Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients 90 years undergoing endovascular stroke treatment. MATERIALS AND METHODS: We retrospectively analyzed prospectively collected data of patients 90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS). RESULTS: Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2 or exhibited prestroke mRS, and 24.1% achieved mRS 0-3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical sequelae). CONCLUSIONS: Despite high mortality rates and only moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred. Therefore, very high age should not per se be an exclusion criterion for endovascular stroke treatment.