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Abstract Details

Outcomes of Endovascular Thrombectomy in Nonagenarians Compared to Younger Patients Selected By Perfusion Imaging – A Matched Cohort Study
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
041

We aimed to evaluate safety and efficacy of EVT in nonagenarians with perfusion imaging selection.
Endovascular thrombectomy (EVT) is a proven therapy for appropriately selected patients with large vessel occlusions (LVO) up to 24 hours from symptom onset. There is scarce information on the outcomes of older patients, especially nonagenarians.  
We retrospectively analyzed prospectively collected data from a large academic hospital between December 2017 and October 2019. Demographics, clinical characteristics, imaging data and outcomes were collected. Patients receiving EVT for anterior circulation LVO were stratified into nonagenarian (≥ 90 years) and younger (< 90 years) groups, and the two groups were matched by propensity score pair matching (1:4) without replacement. We matched groups on 17 covariates including: gender, comorbidities, NIHSS, thrombolytic use, transfer status, estimated ischemic core volume, estimated mismatch volume and door to groin puncture. In the final matched cohort we compared: successful reperfusion (TICI 2B/3), inpatient mortality, symptomatic intracranial hemorrhage (sICH) and mRS in patients surviving to discharge using McNemar’s test.

Overall, 214 consecutive patients (26 ≥ 90 years and 188 <90 years) underwent EVT. In the matched cohort, mortality rate during hospitalization was significantly greater in nonagenarians compared to younger patients (43.5% vs. 10.4%), OR = 9.33 (95%CI 2.88 – 47.97), p<0.0001, and a greater proportion of nonagenarians developed sICH compared to younger patients (13.0% vs. 3.0%), OR = 6.00 (95%CI 1.34 – 55.20), p=0.02. There were no significant differences in the proportion of matched nonagenarians or younger patients achieving a successful reperfusion (91.3% vs. 90.9%), p=1.00 or achieving functional independence when patients survived to discharge (23.1% vs. 32.2%), p=0.75.

We observed that nonagenarians have a significantly higher mortality and sICH rates following EVT compared to matched younger patients. Nonagenarians undergoing EVT had similar rates of successful reperfusion and functional independence compared to the younger cohort.
Authors/Disclosures
Rahul H. Rahangdale, MD
PRESENTER 		Dr. Rahangdale has nothing to disclose.
Chris Hackett, MA Mr. Hackett has nothing to disclose.
No disclosure on file
Russell M. Cerejo, MD (Allegheny health Network) Dr. Cerejo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Ischemaview.
Konark Malhotra, MD (Allegheny Health Network) Dr. Malhotra has nothing to disclose.
No disclosure on file
No disclosure on file
Sandeep S. Rana, MD, FÂ鶹´«Ã½Ó³»­ (Allegheny Health Network) Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSI. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pharmawrite. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for amylyx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion.