Direct aspiration thrombectomy as a first-pass approach for very elderly patients with ischemic stroke

Abstract

Objective: This study aimed to determine whether an age of ≥ 80 years would affect the radiological and clinical outcomes of the direct aspiration first pass strategy for large vessel occlusion.

Methods: This study analyzed single-center data of patients with stroke who were treated with mechanical thrombectomy between May 2018 and October 2020. Baseline characteristics, as well as radiological and clinical outcomes of patients were recorded, analyzed, and compared between the very elderly (≥80 years) and elderly patients (<80 years).

Results: Sixty patients underwent mechanical thrombectomy using the Sofia aspiration catheter for mainstem occlusion of the middle cerebral artery. The direct aspiration first pass strategy was effective in 56.3% (n = 9) and 54.4% (n = 24) in the very elderly and elderly groups, respectively (p = 0.907). The final successful recanalization rates (thrombolysis in cerebral infarction ≥2b) were 75.0% (n = 12) and 70.5% (n = 31) in the very elderly group and elderly groups, respectively (p = 0.999). There was no significant between-group difference in the good 90-day clinical outcome (modified Rankin Scale ≤2) (50.0% and 56.8% in the very elderly and elderly groups, respectively, p = 0.639). Further, there were no significant between-group differences in complication rates.

Conclusion: There was no difference in the recanalization rates and clinical outcomes of the direct aspiration first-pass strategy for patients aged ≥ 80 and < 80 years with occlusive lesions in large vessels.

Keywords: Elderly; Infarction; Stroke; Thrombectomy.