Objective: Multiple randomized trials have confirmed that endovascular thrombectomy (ET) is an effective treatment method for patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, patients older than eighty years of age show worse functional outcomes and higher mortality rates after ET. Our retrospective study aimed to confirm the efficacy of ET in older patients and identify characteristics or variables that can be associated with a better or worse outcome of ET.
Methods: The data of 102 patients with AIS aged 80 years or older were retrospectively collected from January 2019 to September 2020 from the Clinical University Hospital of Split (Department of Neurology). All patients had the AIS caused by occlusion of the M1 segment of the middle cerebral artery (MCA), 51 of them were treated with ET, and 51 of them received general supportive measures (symptomatic therapy - ST group). Detailed demographic information about age, gender, previous diseases (stroke risk factors), baseline National Institute of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS), as well as NIHSS and mRS at discharge, were collected. In addition, concomitant use of recombinant tissue-type plasminogen activator, symptom onset to hospital admission time, time from admission to groin puncture, thrombectomy duration, and thrombolysis in cerebral infarction scale (TICI) recanalization grading scores were collected.
Results: Rates of functional independence (mRS score 0-2) were significantly higher among elderly patients treated with ET than with ST (14 vs. 8% respectively, Z = 1.98, p < 0.05). Mortality in the ET group was 33%, while in the ST group was 41%, and no statistically significant difference was found. TICI 2b and 3 negatively correlate with thrombectomy duration (r = -0.39; p < 0.05). Patients with a good outcome had significantly better TICI scores (86% of patients had TICI 2b and 3) and lower NIHSS at admission (12.6 ± 5.4 vs. 16.4 ± 3.6 in the group with poor outcome, p < 0.01). Hypertension (HTN) showed to be an independent predictor of poor clinical outcome (OR 4, p = 0.03, CI 1.11-14.35).
Conclusions: Outcomes of ET among older adults are better than among the older adults treated with ST. The lower NIHSS at the admission, shorter duration of ET, and better TICI could be the predictors of good ET outcome, while HTN could be a predictor of poor outcome. Better patient selection and more studies of ET in the elderly are needed.
Keywords: Acute ischemic stroke; Endovascular thrombectomy; Older adults; Outcome; Thrombectomy.
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