Background

Pooled data of randomized controlled trials investigating mechanical thrombectomy (MT) to treat anterior circulation large vessel occlusion have demonstrated safety and effectiveness across all age groups, including ≥ 80 years of age; however, only a few nonagenarians were in the ≥ 80 years subgroup. Therefore, the benefit of MT in nonagenarians is mostly unknown.

Methods

Two comprehensive stroke centers retrospectively reviewed all acute ischemic stroke patients who underwent MT for anterior circulation large vessel occlusion (LVO) stroke between February 2016 and August 2020. Revascularization TICI2b/3, symptomatic intracranial hemorrhage (ICH), and functional outcome using modified Rankin scale (mRS) were assessed for cases aged < 80 years, 80–89 years, and 90–99 years. Favorable functional outcome was defined as mRS 0–2 or reaching the prestroke mRS and moderate as mRS 0–3.

Results

The final data set comprised a total of 736 cases. Of these, 466 aged < 80 years, 219 aged 80–89 years, and 51 aged 90–99 years. In nonagenarians, TICI 2b/3 revascularization was observed in 84.3% while symptomatic ICH was observed in 4%. These rates were similar to 80–89 years and < 80 years age groups. Favorable and moderate functional outcome as well as death rates differed significantly between nonagenarians and < 80 years (19.6%, 29.4%, 51.0% vs 47.9%, 60.7%, 18.7%, respectively, p < 0.001), but were similar between nonagenarians and octogenarians (29.7%, 38.8%, 38.8%, p = 0.112–0.211).

Conclusion

A moderate outcome among nonagenarians was observed in about 30%, while mortality rates were about 50%. Withholding mechanical thrombectomy does not appear justifiable, although the absolute treatment effect among nonagenarians remains unknown.

中文翻译：

---

老年人前循环大血管闭塞中风机械取栓后的结果

背景

调查机械血栓切除术 (MT) 治疗前循环大血管闭塞的随机对照试验的汇总数据已证明所有年龄组（包括 80 岁以上）的安全性和有效性；然而，只有少数九岁老人在 ≥ 80 岁的亚组中。因此，MT 对九岁老人的益处大多未知。

方法

两个综合卒中中心回顾性分析了 2016 年 2 月至 2020 年 8 月期间因前循环大血管闭塞 (LVO) 卒中接受 MT 的所有急性缺血性卒中患者。血运重建 TICI2b/3、症状性颅内出血 (ICH) 和使用改良 Rankin 量表的功能结果(mRS) 对年龄 < 80 岁、80-89 岁和 90-99 岁的病例进行了评估。良好的功能结果定义为 mRS 0-2 或达到卒中前 mRS，中度定义为 mRS 0-3。

结果

最终数据集共包含 736 个案例。其中，466 人年龄 < 80 岁，219 人年龄在 80-89 岁，51 人年龄在 90-99 岁。在非老年患者中，TICI 2b/3 血运重建在 84.3% 中观察到，而在 4% 中观察到有症状的 ICH。这些比率与 80-89 岁和 < 80 岁年龄组相似。良好和中等的功能结果以及死亡率在 80 岁以下和 80 岁以下的人之间存在显着差异（分别为 19.6%、29.4%、51.0% 和 47.9%、60.7%、18.7%，p  < 0.001），但在九岁和八十多岁的人（29.7%、38.8%、38.8%，p  = 0.112–0.211）。

结论

在约 30% 的老年人中观察到中等结果，而死亡率约为 50%。停止机械取栓似乎是不合理的，尽管在非老年患者中的绝对治疗效果仍然未知。