Clinical frailty and outcome after mechanical thrombectomy for stroke in patients aged ≥ 80 years

J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106816. doi: 10.1016/j.jstrokecerebrovasdis.2022.106816. Epub 2022 Oct 8.

Abstract

Objectives: Data concerning the results of endovascular thrombectomy (EVT) in old patients is still limited. We aimed to investigate the outcomes in thrombectomy-treated ischemic stroke patients aged ≥ 80 years, focusing on frailty as a contributing factor.

Patients and methods: We performed a single-centre retrospective cohort study with 159 consecutive patients aged ≥ 80 years and treated with EVT for acute ischemic stroke between January 1st 2016 and December 31st 2019. Pre-admission frailty was assessed with the Clinical Frailty Scale (CFS). Patients with CFS ≥ 5 were defined as frail. The main outcome was very poor outcome defined as mRS 4-6 at three months after EVT. Secondary outcomes were recanalization status, symptomatic intracerebral haemorrhage (sICH), and one-year survival. Finally, we recorded if the patient returned home within 12 months.

Results: Very poor outcome was observed in 57.9% of all patients (52.4% in non-frail and 79.4% in frail patients). Rates of recanalization and sICH were comparable in frail and non-frail patients. Of all patients, 46.5% were able to live at home within 1 year after stroke. One-year survival was 59.1% (65.6% in non-frail and 35.3% in frail patients). In logistic regression analysis higher admission NIHSS, not performing thrombolysis, lack of recanalization and higher frailty status were all independently associated with very poor three-month outcome. Factors associated with one-year mortality were male gender, not performing thrombolysis, sICH, and higher frailty status.

Conclusion: Almost 60% of studied patients had very poor outcome. Frailty significantly increases the likelihood of very poor outcome and death after EVT-treated stroke.

Keywords: Elderly; Frailty; Ischemic stroke; Thrombectomy.

MeSH terms

  • Brain Ischemia* / therapy
  • Cerebral Hemorrhage / etiology
  • Endovascular Procedures*
  • Female
  • Frailty* / complications
  • Frailty* / diagnosis
  • Humans
  • Ischemic Stroke*
  • Male
  • Retrospective Studies
  • Stroke* / complications
  • Stroke* / diagnosis
  • Stroke* / therapy
  • Thrombectomy / adverse effects
  • Thrombectomy / methods
  • Treatment Outcome