Richard Jackson, MD
Drouard-de Rousiers E, Lucas L, Richard S, Consoli A, Mazighi M, Labreuche J, et al. Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy: Insights From the ETIS Registry. Stroke. 2019;50:3164–3169.
Dr. Drouard-de Rousiers et al. performed a retrospective analysis of all patients over 90 years old who received endovascular therapy in the Endovascular Treatment in Ischemic (ETIS) registry from 2013-2018.
The study is based on observational data retrospectively gathered from multiple sites, all devices were third generation, clinical and radiographic data were evaluated on admission, and CT or MRI was performed between 12 and 72 hours to track hemorrhagic transformation. The patients with successful reperfusion had OR 3.26 of having lower 90-day mRS mainly driven by decreased mortality. The caveat to this benefit is that procedural complications were 16.5% including vessel perforations and dissections.
The main limitation was the small sample size, which is also mentioned as one of the largest studies to date, and a citation of a study by Alaweigh et al. in JNIS of 108 patients in which ET in the >80 year old age group did not have a benefit compared to medical management.
This was a very informative study for me for two reasons. First, the article referenced and cited a recent retrospective article by Sagnier et al. in BMC Geriatrics of 78 patients evaluated by CTP with a mismatch for IV thrombolysis, which showed that outcomes were not different between thrombolysis and medical management, but there was a higher risk of ICH 54% vs 12%. Second, the article shows that successful reperfusion with endovascular therapy could be a major determinant of good outcome and lower mortality. Both of which are important considerations for any physician taking stroke calls when a code is initiated, as this is becoming more of a common occurrence with the aging population.