Mechanical Thrombectomy in Nonagenarians with Acute Ischemic Stroke: Our Institutional Experience
Chetna Dengri1, Pramit Mukherjee1, Nestor Galvez-Jimenez1
1Neurology, Cleveland Clinic Florida
Objective:
To describe our past 6-year institutional experience of outcomes of Mechanical Thrombectomy (MT) in nonagenarians
Background:
Safety and efficacy of MT for acute ischemic stroke in patients ≥ 90 years have not been exclusively investigated by randomized controlled trials (RCT) till date. Various meta-analyses, systematic reviews and subgroup analyses of RCTs have revealed inconsistent results regarding safety and efficacy of MT in this patient population. Our study aims to contribute to the existing body of literature.
Design/Methods:
This was a retrospective chart review of patients ≥ 90 years who underwent mechanical thrombectomy at our institution from January 2017 to January 2023, approved by our IRB. Baseline demographics, comorbidities, mRS, clinical examination and intervention details were collected.
Results:
12 patients met the inclusion criteria with 9 of them (75%) being female. The most common risk factors present were hypertension (83.3%), hyperlipidemia (75%) and atrial fibrillation (66.6%). Pre-stroke mRS ranged between 0-3 with 33.3% having a score of ≤2. Initial NIHSS was <5 in 8.3% of patients, between 5-25 in 83.3% and >25 in 8.3%. 2 out of 12 patients (16.6%) received intravenous thrombolysis with Tenecteplase prior to MT. Successful recanalization was achieved in 91.6% patients (TICI Grade ≥2b) while recanalization was unsuccessful (TICI Grade 0) in 8.3% patients. No intra-intervention complications were reported in any of the patients. In 1 patient (8.3%), the ischemic stroke evolved despite intervention. 2 mortalities (16.6%) were reported post-intervention during hospitalization and 2 more (16.6%) were reported within 90 days of discharge. mRS scores remained unchanged from discharge till 90 days after for all the surviving patients (66.6%).
Conclusions:
Mechanical thrombectomy can be successfully performed without resulting in significant intra-operative complications in nonagenarians with acute ischemic stroke. However, it does not appear to result in significant functional improvement up to 90 days post-discharge in the same population.