Nonagenarians with pre-existing dependency treated with endovascular thrombectomy for ischaemic stroke achieve comparable functional outcomes with their independent peers, a WA-based study has shown.
The researchers say their findings suggest that age or dependency alone should not automatically exclude patients from the procedure.
The retrospective cohort study involved 106 patients aged 90 or older who underwent endovascular thrombectomy for ischaemic stroke secondary to large vessel occlusion in WA between June 2016 and September 2021.
Researchers allocated 61 patients to group A representing independency before stroke (pre-stroke modified Rankin Scale 0-2) and 45 patients to group B representing dependency before stroke (pre-stroke modified Rankin Scale >2).
No patients had pre-stroke mRS 5.
At baseline, group B had more pre-existing cognitive impairment, aged care facility residents, higher median age and lower Alberta Stroke Program Early CT Score.
Findings showed that 38% of patients in group A and 49% in group B achieved a favourable clinical outcome for functional status, which was defined as a 90-day post-stroke mRS category equal to patients’ respective pre-stroke mRS category.
Writing in the Journal of Stroke and Cerebrovascular Diseases [link here], the researchers said the difference between the groups was not significant.
For secondary outcome measures, group B had a significantly higher 90-day mortality rate at 47% versus 24% in group A. However, there was no difference in the inpatient and one-year mortality rate between the groups.
Common causes of death for inpatient mortalities were aspiration pneumonia and haemorrhagic complications following endovascular thrombectomy.
Other causes of death across both groups included malignant cerebral infarct, recurrent cerebral infarct, myocardial infarction and acute pulmonary oedema.
All other secondary outcome measures were similar between the two groups, including the rate of successful reperfusion (92% versus 98%) and symptomatic intracranial haemorrhage (6.6% versus 11%), hospital length-of-stay (21 versus 16 days) and change in accommodation to an aged care facility (57% versus 49%).
“This suggests that pre-stroke dependent patients are not more technically challenging to perform EVT on, and that they probably do not fare worse from receiving EVT versus standard medical therapy alone,” wrote the authors.
“Our results appear comparable to some recent studies supporting the view that patients should not be excluded from EVT based on old age alone. Ultimately, it is fundamental that informative discussion occurs with patients and their family during the process of shared decision making for their best management.”
However, the researchers from Perth-based hospitals noted it was difficult to determine the exact degree of benefit or harm experienced by both groups as a result of the endovascular thrombectomy as there were no data of patients who received best medical therapy without the procedure for comparison.
Further, because of the very small number of posterior circulation strokes, the conclusions might only apply to anterior circulation strokes.