Endovascular thrombectomy in octogenarians and nonagenarians with large vessel occlusion: Technical aspects and clinical outcome.

BACKGROUND: Safety and efficacy of thrombectomy in patients ≥80-year-old is not fully understood as this age group is underrepresented in major clinical trials. OBJECTIVES: To review the procedural aspects and clinical outcome of thrombectomy among octogenarians and nonagenarians in a busy comprehensive stroke center. METHODS: We retrospectively identified all patients ≥80-year-old who underwent thrombectomy for acute ischemic stroke with emergent large vessel occlusion (ELVO) in the anterior circulation in our institution. Demographics, procedural variables, anesthesia modality, and clinical outcome measures were extracted. The rates of successful recanalization (defined as TICI ≥ 2B), symptomatic hemorrhagic transformation and favorable clinical outcome (defined as mRS<3 at 90 days) were identified. RESULTS: A total of 113 patients were identified. The median age for the cohort was 85 years (range: 80-103). Median admission NIHSS score was 18 (IQR: 14-25). Successful recanalization was achieved in 101 patients (89%). Monitored anesthesia care (MAC) was used in 78% of the patients. Groin puncture to recanalization time was shorter in patients under MAC (45±36 vs 120±50; p=0.006); however, no statistically significant difference in the rate of 90-day favorable outcome was observed between MAC and general anesthesia(23% vs 20%, p=0.77). From 72 patients with baseline mRS<3, 22% had a favorable 90-day outcome. CONCLUSION: Thrombectomy in octogenarians and nonagenarians is technically feasible and associated with high rate of recanalization. Anesthesia type was not a predictor of outcome and does not pose a threat on procedural time. Nearly one out of four patients in this study had a favorable clinical outcome.

Stent-assisted Woven EndoBridge device for the treatment of intracranial aneurysms: an international multicenter study.

OBJECTIVE: The Woven EndoBridge (WEB) device is an intrasaccular flow disruptor designed for wide-necked bifurcation aneurysms. These aneurysms may require the use of a concomitant stent. The objective of this study was to determine the clinical and radiological outcomes of patients undergoing stent-assisted WEB treatment. In addition, the authors also sought to determine the predictors of a concomitant stent in aneurysms treated with the WEB device. METHODS: The data for this study were taken from the WorldWideWEB Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups based on treatment: stent-assisted WEB and WEB device alone. The authors compared clinical and radiological outcomes of both groups. Univariable and multivariable binary logistic regression analyses were performed to determine factors that predispose to stent use. RESULTS: The study included 691 intracranial aneurysms (31 with stents and 660 without stents) treated with the WEB device. The adequate occlusion status did not differ between the two groups at the latest follow-up (83.3% vs 85.6%, p = 0.915). Patients who underwent stenting had more thromboembolic (32.3% vs 6.5%, p < 0.001) and procedural (16.1% vs 3.0%, p < 0.001) complications. Aneurysms treated with a concomitant stent had wider necks, greater heights, and lower dome-to-neck ratios. Increasing neck size was the only significant predictor for stent use. CONCLUSIONS: This study demonstrates that there is no difference in the degree of aneurysm occlusion between the two groups; however, complications were more frequent in the stent group. In addition, a wider aneurysm neck predisposes to stent assistance in WEB-treated aneurysms.