Universität zu Köln

Meyer, Lukas ORCID: 0000-0002-3776-638X, Alexandrou, Maria, Leischner, Hannes, Flottmann, Fabian ORCID: 0000-0001-8358-8089, Deb-Chatterji, Milani, Abdullayev, Nuran ORCID: 0000-0003-4522-537X, Maus, Volker ORCID: 0000-0001-5097-2631, Politi, Maria, Roth, Christian, Kastrup, Andreas, Thomalla, Goetz, Mpotsaris, Anastasios, Fiehler, Jens and Papanagiotou, Panagiotis (2019). Mechanical thrombectomy in nonagenarians with acute ischemic stroke. J. NeuroInterventional Surg., 11 (11). S. 1091 - 1096. LONDON: BMJ PUBLISHING GROUP. ISSN 1759-8486

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Abstract

Background Mechanical thrombectomy (MT) is a safe and effective therapy for ischemic stroke. Nevertheless, very elderly patients aged >= 90 years were either excluded or under-represented in previous trials. It remains uncertain whether MT is warranted for this population or whether there should be an upper age limit. Methods We retrospectively reviewed 79 patients with stroke aged >= 90 years from three neurointerventional centers who underwent MT between 2013 and 2017. Good functional outcome was defined as modified Rankin scale (mRS) <= 2 and assessed at 90-day follow-up. Successful recanalization was graded by Thrombolysis in Cerebral Infarction Scale (TICI) >= 2 b. Feasibility and safety assessments included unsuccessful recanalization attempts (TICI 0), time from groin puncture to recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events. Results Only occlusions within the anterior circulation were included. Median time from groin puncture to recanalization was 39 min (IQR 25-57 min). The rate of successful recanalization (TICI >= 2 b) was 69.6% (55/79). Good functional outcome (mRS <= 2) at 90 days was observed in 16% (12/75) of patients. In-hospital mortality was 29.1% (23/79) and increased significantly at 90 days (46.7%, 35/75; p<0.001). sICH occurred in 5.1% (4/79) of patients. No independent predictor for good functional outcome (mRS <= 2) at 90 days was identified through logistic regression analysis. Conclusion MT in nonagenarians leads to high mortality rates and less frequently good functional outcome compared with younger patient cohorts in previous large randomized trials. However, MT appears to be safe and beneficial for a certain number of very elderly patients and therefore should generally not be withheld from nonagenarians.

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 Leischner, Hannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Flottmann, Fabian UNSPECIFIED orcid.org/0000-0001-8358-8089 UNSPECIFIED Deb-Chatterji, Milani UNSPECIFIED UNSPECIFIED UNSPECIFIED Abdullayev, Nuran UNSPECIFIED orcid.org/0000-0003-4522-537X UNSPECIFIED Maus, Volker UNSPECIFIED orcid.org/0000-0001-5097-2631 UNSPECIFIED Politi, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kastrup, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomalla, Goetz UNSPECIFIED UNSPECIFIED UNSPECIFIED Mpotsaris, Anastasios UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Papanagiotou, Panagiotis UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-129033
DOI:	10.1136/neurintsurg-2019-014785
Journal or Publication Title:	J. NeuroInterventional Surg.
Volume:	11
Number:	11
Page Range:	S. 1091 - 1096
Date:	2019
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1759-8486
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ENDOVASCULAR TREATMENT; YOUNGER PATIENTS; THERAPY; METAANALYSIS; ANTERIOR; AGE Multiple languages Neuroimaging; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12903