Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration

Jasmine Jost; Lukas Enz; Martina B. Goeldlin; Philipp Baumgartner; Davide Strambo; Nabila Wali; Nicolas Martinez-Majander; Georg Kägi; Laura Vandelli; Christoph Riegler; Danna Krupka; Matteo Paolucci; Mauro Magoni; Giovanni Bianco; Hamza Jubran; Dejana R. Jovanovic; Tomas Klail; Laura P. Westphal; Alexander Salerno; Leon A. Rinkel; Laura Mannismäki; Tolga Dittrich; Livio Picchetto; Regina von Rennenberg; Miguel Serôdio; Stefano Forlivesi; Dikran Mardighian; Carlo W. Cereda; Ronen R. Leker; Visnja Padjen; Mira Katan; Marios-Nikos Psychogios; Urs Fischer; Tomas Dobrocky; Mirjam R. Heldner; Patrik Michel; Paul J. Nederkoorn; Sami Curtze; Gian Marco de Marchis; Guido Bigliardi; Christian H. Nolte; João Pedro Marto; Andrea Zini; Alessandro Pezzini; Susanne Wegener; Marcel Arnold; Stefan T. Engelter; Henrik Gensicke

doi:10.1177/23969873251360607

Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration

Jasmine Jost
, Lukas Enz
, Martina B. Goeldlin
, Philipp Baumgartner
, Davide Strambo
, Nabila Wali
, Nicolas Martinez-Majander
, Georg Kägi
, Laura Vandelli
, Christoph Riegler
, Danna Krupka
, Matteo Paolucci
, Mauro Magoni
, Giovanni Bianco
, Hamza Jubran
, Dejana R. Jovanovic
, Tomas Klail
, Laura P. Westphal
, Alexander Salerno
, Leon A. Rinkel

Laura Mannismäki, Tolga Dittrich, Livio Picchetto, Regina von Rennenberg, Miguel Serôdio, Stefano Forlivesi, Dikran Mardighian, Carlo W. Cereda, Ronen R. Leker, Visnja Padjen, Mira Katan, Marios-Nikos Psychogios, Urs Fischer, Tomas Dobrocky, Mirjam R. Heldner, Patrik Michel, Paul J. Nederkoorn, Sami Curtze, Gian Marco de Marchis, Guido Bigliardi, Christian H. Nolte, João Pedro Marto, Andrea Zini, Alessandro Pezzini, Susanne Wegener, Marcel Arnold, Stefan T. Engelter, Henrik Gensicke^*

^*Corresponding author for this work

University of Basel
University of Bern
University of Zurich
University of Lausanne
University of Amsterdam
University of Helsinki
Cantonal Hospital St. Gallen
University of Modena and Reggio Emilia
Charité – Universitätsmedizin Berlin
Santa Cruz Hospital
Ospedale Maggiore
Brescia Civil Hospital
Ente Ospedaliero Cantonale
Hadassah University Medical Centre
University of Belgrade
University of Brescia
University of Parma

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0% vs 8.7%). The odds of poor functional outcome (OR_adjusted2.35 (95%-CI 1.87–2.97); 61.6% vs 38.7%), death (OR_adjusted3.04 (95%-CI 2.60–3.55); 53.9% vs 21.3%) and unsuccessful recanalization (OR_adjusted1.34 (95%-CI 1.14–1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (OR_adjusted0.92 (95%-CI 0.66–1.28); 5.1% vs 5.0%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.

Original language	English
Article number	23969873251360607
Journal	European Stroke Journal
Early online date	2025
DOIs	https://doi.org/10.1177/23969873251360607
Publication status	E-pub ahead of print - 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Endovascular therapy
age
elderly
intracranial hemorrhage
stroke

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Cite this

Jost, J., Enz, L., Goeldlin, M. B., Baumgartner, P., Strambo, D., Wali, N., Martinez-Majander, N., Kägi, G., Vandelli, L., Riegler, C., Krupka, D., Paolucci, M., Magoni, M., Bianco, G., Jubran, H., Jovanovic, D. R., Klail, T., Westphal, L. P., Salerno, A., ... Gensicke, H. (2025). Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration. European Stroke Journal, Article 23969873251360607. Advance online publication. https://doi.org/10.1177/23969873251360607

@article{6ff748fee2f14f748fbdd46a569e843f,

title = "Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration",

abstract = "Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95\% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7\%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0\% vs 8.7\%). The odds of poor functional outcome (ORadjusted2.35 (95\%-CI 1.87–2.97); 61.6\% vs 38.7\%), death (ORadjusted3.04 (95\%-CI 2.60–3.55); 53.9\% vs 21.3\%) and unsuccessful recanalization (ORadjusted1.34 (95\%-CI 1.14–1.57); 32.4\% vs 27.2\%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (ORadjusted0.92 (95\%-CI 0.66–1.28); 5.1\% vs 5.0\%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.",

keywords = "Endovascular therapy, age, elderly, intracranial hemorrhage, stroke",

author = "Jasmine Jost and Lukas Enz and Goeldlin, \{Martina B.\} and Philipp Baumgartner and Davide Strambo and Nabila Wali and Nicolas Martinez-Majander and Georg K{\"a}gi and Laura Vandelli and Christoph Riegler and Danna Krupka and Matteo Paolucci and Mauro Magoni and Giovanni Bianco and Hamza Jubran and Jovanovic, \{Dejana R.\} and Tomas Klail and Westphal, \{Laura P.\} and Alexander Salerno and Rinkel, \{Leon A.\} and Laura Mannism{\"a}ki and Tolga Dittrich and Livio Picchetto and \{von Rennenberg\}, Regina and Miguel Ser{\^o}dio and Stefano Forlivesi and Dikran Mardighian and Cereda, \{Carlo W.\} and Leker, \{Ronen R.\} and Visnja Padjen and Mira Katan and Marios-Nikos Psychogios and Urs Fischer and Tomas Dobrocky and Heldner, \{Mirjam R.\} and Patrik Michel and Nederkoorn, \{Paul J.\} and Sami Curtze and \{de Marchis\}, \{Gian Marco\} and Guido Bigliardi and Nolte, \{Christian H.\} and Marto, \{Jo{\~a}o Pedro\} and Andrea Zini and Alessandro Pezzini and Susanne Wegener and Marcel Arnold and Engelter, \{Stefan T.\} and Henrik Gensicke",

note = "Publisher Copyright: {\textcopyright} European Stroke Organisation 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

year = "2025",

doi = "10.1177/23969873251360607",

language = "English",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

}

Jost, J, Enz, L, Goeldlin, MB, Baumgartner, P, Strambo, D, Wali, N, Martinez-Majander, N, Kägi, G, Vandelli, L, Riegler, C, Krupka, D, Paolucci, M, Magoni, M, Bianco, G, Jubran, H, Jovanovic, DR, Klail, T, Westphal, LP, Salerno, A, Rinkel, LA, Mannismäki, L, Dittrich, T, Picchetto, L, von Rennenberg, R, Serôdio, M, Forlivesi, S, Mardighian, D, Cereda, CW, Leker, RR, Padjen, V, Katan, M, Psychogios, M-N, Fischer, U, Dobrocky, T, Heldner, MR, Michel, P, Nederkoorn, PJ, Curtze, S, de Marchis, GM, Bigliardi, G, Nolte, CH, Marto, JP, Zini, A, Pezzini, A, Wegener, S, Arnold, M, Engelter, ST & Gensicke, H 2025, 'Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration', European Stroke Journal. https://doi.org/10.1177/23969873251360607

TY - JOUR

T1 - Safety of endovascular therapy in ischemic stroke patients ⩾90 years

T2 - A cohort study from the EVA-TRISP collaboration

AU - Jost, Jasmine

AU - Enz, Lukas

AU - Goeldlin, Martina B.

AU - Baumgartner, Philipp

AU - Strambo, Davide

AU - Wali, Nabila

AU - Martinez-Majander, Nicolas

AU - Kägi, Georg

AU - Vandelli, Laura

AU - Riegler, Christoph

AU - Krupka, Danna

AU - Paolucci, Matteo

AU - Magoni, Mauro

AU - Bianco, Giovanni

AU - Jubran, Hamza

AU - Jovanovic, Dejana R.

AU - Klail, Tomas

AU - Westphal, Laura P.

AU - Salerno, Alexander

AU - Rinkel, Leon A.

AU - Mannismäki, Laura

AU - Dittrich, Tolga

AU - Picchetto, Livio

AU - von Rennenberg, Regina

AU - Serôdio, Miguel

AU - Forlivesi, Stefano

AU - Mardighian, Dikran

AU - Cereda, Carlo W.

AU - Leker, Ronen R.

AU - Padjen, Visnja

AU - Katan, Mira

AU - Psychogios, Marios-Nikos

AU - Fischer, Urs

AU - Dobrocky, Tomas

AU - Heldner, Mirjam R.

AU - Michel, Patrik

AU - Nederkoorn, Paul J.

AU - Curtze, Sami

AU - de Marchis, Gian Marco

AU - Bigliardi, Guido

AU - Nolte, Christian H.

AU - Marto, João Pedro

AU - Zini, Andrea

AU - Pezzini, Alessandro

AU - Wegener, Susanne

AU - Arnold, Marcel

AU - Engelter, Stefan T.

AU - Gensicke, Henrik

N1 - Publisher Copyright: © European Stroke Organisation 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2025

Y1 - 2025

N2 - Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0% vs 8.7%). The odds of poor functional outcome (ORadjusted2.35 (95%-CI 1.87–2.97); 61.6% vs 38.7%), death (ORadjusted3.04 (95%-CI 2.60–3.55); 53.9% vs 21.3%) and unsuccessful recanalization (ORadjusted1.34 (95%-CI 1.14–1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (ORadjusted0.92 (95%-CI 0.66–1.28); 5.1% vs 5.0%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.

AB - Introduction: Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older. Patients and methods: In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3–5 if pre-stroke mRS 0–2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3–5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0–2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria). Results: Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3–5 (38.0% vs 8.7%). The odds of poor functional outcome (ORadjusted2.35 (95%-CI 1.87–2.97); 61.6% vs 38.7%), death (ORadjusted3.04 (95%-CI 2.60–3.55); 53.9% vs 21.3%) and unsuccessful recanalization (ORadjusted1.34 (95%-CI 1.14–1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (ORadjusted0.92 (95%-CI 0.66–1.28); 5.1% vs 5.0%). Discussion and conclusion: EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.

KW - Endovascular therapy

KW - age

KW - elderly

KW - intracranial hemorrhage

KW - stroke

UR - https://www.scopus.com/pages/publications/105013476794

U2 - 10.1177/23969873251360607

DO - 10.1177/23969873251360607

M3 - Article

C2 - 40801109

SN - 2396-9873

JO - European Stroke Journal

JF - European Stroke Journal

M1 - 23969873251360607

ER -