Universität zu Köln

Meyer, Lukas ORCID: 0000-0002-3776-638X, Alexandrou, Maria, Flottmann, Fabian, Deb-Chatterji, Milani, Abdullayev, Nuran ORCID: 0000-0003-4522-537X, Maus, Volker, Politi, Maria, Bernkopf, Kathleen, Roth, Christian, Kastrup, Andreas, Hanning, Uta ORCID: 0000-0002-7543-8555, Brekenfeld, Caspar, Thomalla, Goetz, Gerloff, Christian, Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164, Papanagiotou, Panagiotis, Fiehler, Jens and Leischner, Hannes (2020). Endovascular Treatment of Very Elderly Patients Aged >= 90 With Acute Ischemic Stroke. J. Am. Heart Assoc., 9 (5). HOBOKEN: WILEY. ISSN 2047-9980

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Abstract

Background Patients aged >= 90 were excluded or under-represented in past thrombectomy trials; thus, uncertainty remains whether treatment benefits can be expected regardless of age. This study investigates outcome and safety of thrombectomy in nonagenarians to improve decision making in a real-world setting. Methods and Results All currently available data of patients aged >= 90 enrolled in the GSR-ET (German Stroke Registry-Endovascular Treatment) were combined with a smaller cohort from 3 tertiary stroke centers. Baseline characteristics, procedural (Thrombolysis in Cerebral Infarction scale) and functional outcomes (modified Rankin Scale; mRS), as well as complications (symptomatic intracranial hemorrhage, serious adverse events; SAEs) were analyzed. Good functional outcome was defined as mRS <= 3 at 90-days. 203 patients with anterior circulation stroke and prestroke mRS <= 3 were included. The rate of successful recanalization (Thrombolysis in Cerebral Infarction scale >= 2b) was 75.9% (154/203). Good functional outcome (mRS <= 3) was observed in 21.6% (41 of 193) at 90-days. In-hospital mortality was 27.1% (55 of 203) and increased significantly at 90 days to 48.9% (93 of 190; P<0.001). Symptomatic intracranial hemorrhage occurred in 3% (6 of 203) of patients. Logistic regression analysis identified Alberta Stroke Program Early CT Score (adjusted odds ratio, 1.93; 95% CI, 1.01-3.70; P=0.046) and initial National Institute of Health Stroke Scale (adjusted odds ratio, 0.85; 95% CI, 0.76-0.97; P=0.014) as independent predictors for good outcome. Patients with successful recanalization had a significant (P=0.001) shift of mRS distribution with higher rates of good functional outcomes (23.8% [34 of 143] versus 14.9% [7 of 47]) and lower mortality at 90-days (46.8% [67 of 143] versus 55.3% [26 of 47]). Conclusions Despite high mortality and less frequent favorable outcome, our data suggest that thrombectomy is still effective and safe for nonagenarians. Decision making for thrombectomy in patients aged >= 90 should be based on a case-by-case basis with regard to initial National Institute of Health Stroke Scale and Alberta Stroke Program Early CT Score.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Meyer, Lukas UNSPECIFIED orcid.org/0000-0002-3776-638X UNSPECIFIED Alexandrou, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Flottmann, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Deb-Chatterji, Milani UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdullayev, Nuran UNSPECIFIED orcid.org/0000-0003-4522-537X UNSPECIFIED Maus, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Politi, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernkopf, Kathleen UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kastrup, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Hanning, Uta UNSPECIFIED orcid.org/0000-0002-7543-8555 UNSPECIFIED Brekenfeld, Caspar UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomalla, Goetz UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerloff, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED orcid.org/0000-0002-1275-8164 UNSPECIFIED Papanagiotou, Panagiotis UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Leischner, Hannes UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-341499
DOI:	10.1161/JAHA.119.014447
Journal or Publication Title:	J. Am. Heart Assoc.
Volume:	9
Number:	5
Date:	2020
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	2047-9980
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MECHANICAL THROMBECTOMY; YOUNGER PATIENTS; STENT-RETRIEVER; REVASCULARIZATION; NONAGENARIANS; THERAPY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34149