Mechanical Thrombectomy in Very Elderly (octogenarian and nonagenarians) with Acute Ischemic Stroke: Do or Not to Do? - Abstract
Background: There is limited data available for the benefits of endovascular therapy (EVT) in elderly with large vessel occlusion (LVO) and the necessity of administering thrombolytic agent before mechanical thrombectomy (MT). Methods: We conducted a retrospective study looking at the benefits of EVT alone compared to administer alteplase (tPA) bridging with EVT in elderly population in the setting of LVO. We included patients (age > 80) who underwent EVT between January1, 2017 to December 31, 2019. We looked at primary outcome functional status with modified Rankin scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at 90-day after stroke. Additionally, we evaluated whether dual therapy of tPA plus EVT would enhance the benefit from EVT alone. Results: We enrolled total of 98 patients and divided into 2 subgroups: received both tPA plus MT (34 patients) versus MT alone (64 patients). We found EVT alone was noninferior to the bridging therapy. There is no significant difference in terms of functional outcome based on mRS at 90 days. No statistical difference was found between 2 groups in terms of hemorrhagic complications and mortality. Secondarily looking at the functional recovery, patients who came in with severe initial NIHSS had significant improvement in discharge NIHSS compared to patients with mild-moderate initial NIHSS. Conclusions: Our study found that in elderly population dual therapy with tPA and MT is non-superior to MT alone. Functional outcomes at 90-day post stroke did not reveal any significant difference evaluated with the mRS between the two groups.