Background: Little is known on the outcomes of nonagenarians treated with endovascular therapy for acute large vessel occlusion stroke. It is unclear whether they have worse clinical outcomes than octogenarians.
Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-Dec 2016. All patients older than 80 years that underwent endovascular therapy for large vessel occlusion acute ischemic stroke were included and categorized into two groups: 80-89 years (octogenarians), and 90-99 years (nonagenarians). Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.
Results: Thirty-one nonagenarians and 181 octogenarians were treated over the 6-year study period. When compared with octogenarians, nonagenarians had lower glucose levels (121±26 vs 138±46, p<0.01) and were less often males (16% vs 34%, p=0.05). Other baseline characteristics including comorbidities, NIHSS, ASPECT scores and stroke location as well as procedural parameters were comparable between groups. In terms of outcomes, rates of successful reperfusion (mTICI 2b-3) (87.1% vs 87.9%, p=1.0), parenchymal hematomas (12.9% vs12.7%, p=1.0), and 90-day mortality (51.6% vs 41.4%, p=0.3) were comparable. There was a non-significant trend toward better 90-Day independent outcomes (modified Rankin scale, mRS 0-2) favoring octogenarians (12.9% vs 27.2%, p=0.09) while ambulatory outcomes were more similar (mRS 0-3) (29% vs 41.4%, p=0.2). In multivariate analysis, only baseline NIHSS (Beta -0.09 95%CI[-0.18_-0.02], p=0.02) and successful reperfusion (Beta 1.61 95%CI[0.16-21.23]) were associated with independent outcome.
Conclusions: Our study shows that there is no significant difference in procedural and clinical outcomes between nonagenarians and octogenarians treated with endovascular therapy. Baseline stroke severity and successful reperfusion are the main drivers of favorable functional outcome in patients ≥80years old.