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Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy

Eve Drouard-de Rousiers 1 Ludovic Lucas 2 Sébastien Richard 3, 4 Arturo Consoli 1, 5 Mikaël Mazighi 6 Julien Labreuche 7 Maéva Kyheng 8 Benjamin Gory 5, 9 Cyril Dargazanli 10 Caroline Arquizan 11 Gaultier Marnat 12 Raphaël Blanc 6 Hubert Desal 13 Romain Bourcier 13 Igor Sibon 12 Bertrand Lapergue 1 Michel Piotin Simon Escalard Jean-Philippe Desilles Hocine Redjem Gabriele Ciccio Stanislas Smajda Robert Fahed Mikael Obadia Candice Sabben Ovide Corabianu Thomas de Broucker Didier Smadja Sonia Alamowitch Olivier Ille Eric Manchon Pierre-Yves Garcia Guillaume Taylor Malek Ben Maacha Adrien Wang Serge Evrard Maya Tchikviladze Vadim Afanasiev Nadia Ajili Bénédicte Sensenbrenner Oguzhan Coskun Federico Di Maria Georges Rodesch Bruno del Sette Riccardo Russo Katsuhiro Mizutani Morgan Leguen Julie Gratieux Fernando Pico Haja Rakotoharinandrasana Philippe Tassan Roxanna Poll Norbert Nighoghossian Roberto Riva Omer Eker Francis Turjman Laurent Derex Tae-Hee Cho Laura Mechtouff Anne Claire Lukaszewicz Frédéric Philippeau Serkan Cakmak Karine Blanc-Lasserre Anne-Evelyne Vallet Florent Gariel Xavier Barreau Jérôme Berge Louis Veunac Patrice Menegon Stéphane Olindo Pauline Renou Sharmila Sagnier Mathilde Poli Sabrina Debruxelles Lili Detraz Benjamin Daumas-Duport Pierre-Louis Alexandre Monica Roy Cédric Lenoble Vincent L’allinec Jean-Baptiste Girot Solène de Gaalon Benoit Guillon Serge Bracard 5 René Anxionnat 5 Marc Braun 5 Anne-Laure Derelle Romain Tonnelet Liang Liao François Zhu 5 Emmanuelle Schmitt Sophie Planel Lisa Humbertjean Gioia Mione Jean-Christophe Lacour Mathieu Bonnerot Nolwenn Riou-Comte Isabelle Costa Anne Chatelain Vincent Costalat Grégory Gascou Pierre-Henri Lefèvre Imad Derraz Carlos Riquelme Nicolas Gaillard Isabelle Mourand Et Lucas Corti Eugene Francois Stéphane Vannier
Abstract : Background and Purpose— Nonagenarians represent a growing stroke population characterized by a higher frailty. Although endovascular therapy (ET) is a cornerstone of the management of acute ischemic stroke related to large vessel occlusion, the benefit of reperfusion among nonagenarians is poorly documented. We aimed to assess the impact of ET-related reperfusion on the functional outcome of reperfusion in this elderly population. Methods— A retrospective analysis of clinical and imaging data from all patients aged over 90 included in the ETIS (Endovascular Treatment in Ischemic Stroke) registry between October 2013 and April 2018 was performed. Association between post-ET reperfusion and favorable (modified Rankin Scale [0–2] or equal to prestroke value) and good (modified Rankin Scale [0–3] or equal to prestroke value) outcome were evaluated. Demographic and procedural predictors of functional outcome, including the first-pass effect, were evaluated. Results were adjusted for center, admission National Institutes of Health Stroke Scale, and use of intravenous thrombolysis. Results— Among the 124 nonagenarians treated with ET, those with successful reperfusion had the lowest 90-day modified Rankin Scale (odds ratio, 3.26; 95% CI, 1.04–10.25). Only patients with successful reperfusion after the first pass (n=53, 56.7%) had a reduced 90-day mortality (odds ratio, 0.15; 95% CI, 0.05–0.45) and an increased rate of good outcome (odds ratio, 4.55; 95% CI, 1.38–15.03). No increase in the rate of intracranial hemorrhage was observed among patients successfully reperfused. Conclusions— Successful reperfusion improves the functional outcome of nonagenarians who should not be excluded from ET. The first-pass effect should be considered in the procedural management of this frail population.
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Submitted on : Wednesday, June 23, 2021 - 3:55:17 PM
Last modification on : Sunday, September 19, 2021 - 3:25:28 AM

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Eve Drouard-de Rousiers, Ludovic Lucas, Sébastien Richard, Arturo Consoli, Mikaël Mazighi, et al.. Impact of Reperfusion for Nonagenarians Treated by Mechanical Thrombectomy. Stroke, American Heart Association, 2019, 50 (11), pp.3164-3169. ⟨10.1161/STROKEAHA.119.026448⟩. ⟨hal-03268970⟩

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