Acute Reperfusion Therapies and Prognosis in Nonagenarian Stroke Patients

Nicolas Legris; Louise Bicart-See; Claire Ancelet; Laura Venditti-Maillet; Olivier Chassin; Claire Peillet; Mariana Sarov-Riviere; Olga Laine; Anne-Laure Vetillard; Tom Pujol; Nicoletta Brunetti; Caroline Dupont Deschamps; Elodie Baudry; Laurent Spelle; Alexandra Rouquette; Christian Denier

doi:10.1159/000540872

Acute Reperfusion Therapies and Prognosis in Nonagenarian Stroke Patients

Gerontology. 2024 Oct 31:1-12. doi: 10.1159/000540872. Online ahead of print.

Authors

Nicolas Legris¹, Louise Bicart-See¹, Claire Ancelet², Laura Venditti-Maillet¹, Olivier Chassin¹, Claire Peillet¹, Mariana Sarov-Riviere¹, Olga Laine³, Anne-Laure Vetillard⁴, Tom Pujol⁴, Nicoletta Brunetti⁴, Caroline Dupont Deschamps⁵, Elodie Baudry⁵, Laurent Spelle², Alexandra Rouquette⁶, Christian Denier⁷

Affiliations

¹ Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Saclay University, Le Kremlin Bicêtre, France.
² Neuroradiology, Bicêtre Hospital, AP-HP, Paris Saclay University, Le Kremlin Bicêtre, France.
³ Hôpital Gériatrique Les Magnolias, Ballainvilliers, France.
⁴ Geriatric Center, Paul Brousse Hôpitaux Universitaires Paris Saclay (HUPS), AP-HP, Villejuif, France.
⁵ Geriatric Center, Bicêtre Hospital, AP-HP, Paris Saclay University, Le Kremlin Bicêtre, France.
⁶ Public Health and Epidemiology Department, AP-HP, Bicêtre HUPS, Université Paris Saclay, CESP, Inserm, Le Kremlin Bicêtre, France.
⁷ Department of Neurology, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Saclay University, Le Kremlin Bicêtre, France, christian.denier@aphp.fr.

PMID: 39481359
DOI: 10.1159/000540872

Abstract

Introduction: Thrombolysis and endovascular thrombectomy (EVT) are standard treatments after stroke. We previously reported that these therapies benefit stroke patients over 80 years old. Now, we aimed to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group.

Methods: Nonagenarian stroke patients were identified from our prospective monocentric cohort, which included consecutive patients ≥80 years old treated with thrombolysis and/or EVT from 2015 to 2019. Baseline characteristics, treatments, and outcomes, as well as complications and mortality were analyzed.

Results: Ninety-six nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). A total of 51% had a pre-stroke modified Rankin score (mRS) ≤2. Cardioembolism was the most common etiology (67.7%). Age was associated with a higher mRS after stroke with a turning point at 90 years old: (90-99 years old: odds ratio [OR] = 0.33, 95% confidence interval [95% CI]: 0.13-0.83, p = 0.02) versus (85-89 years old: OR = 0.72, 95% CI: 0.34-1.50, p = 0.38), with 80- to 84-year-old patients as the reference. In nonagenarians, previous coronary artery disease (OR = 8.02, 95% CI: 1.66-38.68, p = 0.01), initial National Institute of Health Stroke Score (NIHSS) (OR = 1.11, 95% CI: 1.03-1.19, p = 0.01), pre stroke independence (OR = 0.25, 95% CI: 0.08-0.71, p = 0.01), and "drip-and-ship" status (OR = 3.35, 95% CI: 1.22-9.16, p = 0.02) were associated with 3-month mortality. Nonagenarians had more baseline comorbidities (p = 0.003) and lower levels of pre-stroke independence (p = 0.002) than octogenarians (n = 261). Despite no difference in the use of acute treatments, timelines, and rates of successful reperfusion, a good functional status at 3 months was less common in nonagenarians than octogenarians (14.3% vs. 34.0%, p < 0.001) with a higher mortality (60.2% vs. 16.4%, p < 0.001). A total of 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage.

Conclusions: Age is a crucial factor affecting prognosis after stroke with a turning point at 90 years old. However, age alone should not be a limiting factor for treatment decision. Despite higher mortality and poorer functional prognosis overall, some nonagenarians may benefit from reperfusion therapies.

Keywords: Nonagenarians; Prognosis; Stroke; Thrombectomy; Thrombolysis.