Outcomes of mechanical thrombectomy in octogenarians and nonagenarians patients with Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis

Armin Zarrintan; Basel Musmar; Sherief Ghozy; Mohamed Mansour; Ramanathan Kadirvel; David F Kallmes

doi:10.1016/j.ejrad.2024.111506

Outcomes of mechanical thrombectomy in octogenarians and nonagenarians patients with Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis

Eur J Radiol. 2024 May 13:176:111506. doi: 10.1016/j.ejrad.2024.111506. Online ahead of print.

Authors

Armin Zarrintan¹, Basel Musmar², Sherief Ghozy³, Mohamed Mansour⁴, Ramanathan Kadirvel⁵, David F Kallmes⁶

Affiliations

¹ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. Electronic address: zarrintan.armin@mayo.edu.
² Department of Neurosurgery, Duke University Hospital, Durham, NC, USA. Electronic address: baselmusmar33@gmail.com.
³ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. Electronic address: ghozy.sherief@mayo.edu.
⁴ Department of Neurology, George Washington University, Washington, DC, USA. Electronic address: mohamed13390@fmed.bu.edu.eg.
⁵ Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. Electronic address: kadir@mayo.edu.
⁶ Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: kallmes.david@mayo.edu.

PMID: 38759542
DOI: 10.1016/j.ejrad.2024.111506

Abstract

Purpose: Acute ischemic stroke (AIS) imposes a major healthcare burden, with the elderly population often underrepresented in clinical trials. This systematic review and network meta-analysis aims to evaluate the safety and efficacy of mechanical thrombectomy (MT) among octogenarians and nonagenarians with AIS due to large vessel occlusion (LVO).

Methods: A systematic search was conducted using PubMed, Web of Science, and Scopus databases. Outcomes of interest were modified Rankin Scale (mRS) score of 0-2, thrombolysis in cerebral infarction (TICI) score of 2b-3, 90-day mortality, and symptomatic intracerebral hemorrhage (sICH). The study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Results: The analysis included 47 studies. Significantly lower rates of mRS score 0-2 were observed in nonagenarians (17.4 %) and octogenarians (21.3 %) compared to younger (40.2 %) patients (Odds Ratio (OR) = 3.30, 95 % Confidence Interval (CI):2.35-4.65 and OR = 2.47, 95 % CI: 2.07-2.94). 90-day mortality was significantly higher in nonagenarians (38.9 %) compared to octogenarians (25.4 %) and younger (14.0 %) patients (OR = 0.58, 95 % CI: 0.41-0.83 and OR = 0.31, 95 % CI: 0.21-0.44), and in octogenarians compared to younger patients (OR = 0.52, 95 % CI: 0.41-0.66). No significant differences were observed in TICI 2b-3 and sICH rates across groups.

Conclusions: Our findings indicate that MT is a viable treatment option for AIS due to LVO among octogenarians and nonagenarians, albeit with nuanced differences. Specifically, octogenarians had lower 90-day mortality rates compared to nonagenarians. These insights support the need for individualized treatment plans for elderly patients with AIS due to LVO and highlight the importance of including this demographic in future clinical trials.

Keywords: Acute Ischemic Stroke; Mechanical Thrombectomy; Nonagenarians; Octogenarians.