Acute stroke treatment with mechanical thrombectomy without IV tPA in nonagenarian patients: A single-center experience

Abstract

Age is one of the most critical non-modifiable risk factors for stroke. With the increasing aging of the global population, the incidence of stroke is expected to increase. The current evidence makes treatment decisions regarding MT in patients over 90 years of age challenging. The aim of this study is to evaluate the efficacy of mechanical thrombectomy (MT) and the factors associated with outcomes in patients aged 90 years and older. This is an observational study that follows STROBE guidelines. Patients aged 90 years and older with a pre-stroke Modified Rankin Scale (mRS) score of 0–1 a proximal large-vessel occlusion, who did not receive IV tPA were included in the study. A total of 28 patients were included. To assess clinical outcomes, the 90-day mRS score was evaluated. Patients were categorized into two groups: good clinical outcome (mRS 0–2) and poor clinical outcome (mRS 3–6). The mean age was 91.2 ± 1.5 years. Female patients accounted for 71.4%. The mean National Institutes of Health Stroke Scale (NIHSS) score was 18.7 ± 4.3. Hypertension was the most common comorbidity. The admission glucose levels were significantly higher in the poor clinical outcome group (p = 0.03). Type 3 aortic arch was significantly more frequent in the group with poor clinical outcomes. Isolated middle cerebral artery (MCA) occlusion was significantly more common in the good clinical outcome group (p = 0.03). Our findings suggest that MT can be successful in certain nonagenarian patients. In this study, we identified that admission blood glucose level, aortic arch morphology, location of the occluded vessel, and puncture-to-recanalization time are determinant factors for clinical outcomes.