Introduction: Though some randomized trials of mechanical thrombectomy included octo- and nonagenarians, there is little data on outcomes among the oldest of the old.
Methods: Consecutive patients with ischemic stroke admitted to a single, comprehensive stroke center were prospectively enrolled in a registry between 9/2014-2/2017. Rates of mechanical thrombectomy were compared over 10-year patient age epochs. Among those who underwent thrombectomy, recanalization rates, and discharge disposition were compared over age epochs after adjusting for admission NIHSS using multivariable logistic regression analysis. Cochrane-Armitage test of trend was used to assess for dose effect of age on discharge disposition. Good discharge disposition was defined as discharge to home, acute rehabilitation or outpatient physical therapy.
Results: Of 1245 ischemic stroke patients, 221 (18%) underwent mechanical thrombectomy. Thrombectomy occurred in 13/75 (17%) aged 40-49, 23/176 (13%) aged 50-59, 41/274 (15%) aged 60-69, 53/289 (18%) aged 70-79, 55/287 (19%) aged 80-89, and 30/108 (28%) aged 90-99. There was no significant difference in thrombectomy rates per age epoch after adjusting for NIHSS. TICI2b-3 recanalization rates (85-93% of cases), IV tPA use (25/221, 11%), and withdrawal of life-sustaining therapy (7%) did not differ significantly across age epochs. However, after adjusting for admission NIHSS, the rates of good discharge disposition decreased proportionately, in a dose effect manner with each 10-year increase in age (Cochrane-Armitage 16.06, P<0.001, adjusted odds ratio 0.7, 95%CI 0.6-0.9, P=0.002). Good discharge disposition occurred in 69% of those aged 40-49, 61% aged 50-59, 68% aged 60-69, 62% aged 70-79, 46% aged 80-89 and 33% aged 90-99.
Conclusions: Despite similarly excellent recanalization rates among stroke patients aged 80-99 years who underwent mechanical thrombectomy, good discharge disposition was significantly worse in the oldest of the old after adjusting for admission NIHSS. Nonetheless, nearly half of octogenarians and a third of nonagenarians who underwent mechanical thrombectomy were able to go home or to acute rehabilitation.