title: Endovascular treatment of acute ischemic stroke in nonagenarians compared with younger patients in a multicenter cohort.
abstract: BACKGROUND
  Recent studies have demonstrated the superiority of endovascular therapy (EVT) for emergent large vessel occlusion.
  
  
  OBJECTIVE
  To determine the effectiveness of EVT in nonagenarians, for whom data are limited.
  
  
  METHODS
  We retrospectively reviewed clinical and imaging data of all patients who underwent EVT at two stroke centers between January 2012 and August 2014. The 90-day functional outcome (modified Rankin Scale (mRS) score) was compared between younger patients (age 18-89 years; n=175) and nonagenarians (n=18). The relationship between pre-stroke and 90-day post-stroke mRS was analyzed in these two groups. Multivariable analysis of age, recanalization grade, and admission National Institutes of Health Stroke Scale (NIHSS) for predicting outcome was performed.
  
  
  RESULTS
  Age ≥90 years was associated with a poor (mRS >2) 90-day outcome relative to those under 90 (89% vs 52%, OR=8, 95% CI 1.7 to 35.0; p=0.0081). Nonagenarians had a higher pre-stroke mRS score (0.77; 95% CI 0.44 to 1.30) than younger patients (0.24; 95% CI 0.17 to 0.35; p=0.005). No difference was observed between nonagenarians and younger patients in the rate of mRS change from pre-stroke to 90 days (p=0.540). On multivariable regression, age (OR=1.05, 95% CI 1.03 to 1.08; p<0.0001), recanalization grade (OR=0.62 95% CI 0.42 to 0.91; p=0.015), and admission NIHSS (OR=1.07 95% CI 1.02 to 1.13; p=0.01) were associated with a poor 90-day outcome.
  
  
  CONCLUSIONS
  Nonagenarians are at a substantially higher risk of a poor 90-day outcome after EVT than younger patients. However, a small subset of nonagenarians may benefit from EVT, particularly if they have a good pre-stroke functional status. Further research is needed to identify factors associated with favorable outcome in this age cohort.
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.|Neuroscience Institute (Division of Neurology), Spectrum Health, Michigan State University, Grand Rapids, Michigan, USA.
authors.forename: Muhib A
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Lifespan Biostatistics Core, Lifespan Hospital System, Providence, Rhode Island, USA.|Department of Diagnostic Imaging, Brown University, Providence, Rhode Island, USA.
authors.forename: Grayson L
authors.identifier: http://orcid.org/0000-0002-5926-9886
authors.initials: GL
authors.lastname: Baird
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-4905-5128
authors.initials: D
authors.lastname: Miller
authors.affiliation: Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Tsekhan
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Ajit
authors.initials: A
authors.lastname: Puri
authors.affiliation: Department of Diagnostic Imaging, Brown University, Providence, Rhode Island, USA.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Jayaraman
authors.affiliation: Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA.|Department of Psychiatry, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Nils
authors.initials: N
authors.lastname: Henninger
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0002-1562-9894
authors.initials: B
authors.lastname: Silver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Angiography; Intervention; Stroke; Thrombectomy