Mechanical thrombectomy for treatment of acute ischemic stroke in frail patients: a systematic review of the literature

Nisha Dabhi; Jeyan Kumar; Ryan T Kellogg; Min S Park

doi:10.1136/jnis-2023-020476

Mechanical thrombectomy for treatment of acute ischemic stroke in frail patients: a systematic review of the literature

J Neurointerv Surg. 2023 Jul 24:jnis-2023-020476. doi: 10.1136/jnis-2023-020476. Online ahead of print.

Authors

Nisha Dabhi¹, Jeyan Kumar¹, Ryan T Kellogg¹, Min S Park²

Affiliations

¹ Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA.
² Department of Neurosurgery, Univerisity of Virginia, Charlottesville, Virginia, USA MP2TQ@uvahealth.org.

PMID: 37487691
DOI: 10.1136/jnis-2023-020476

Abstract

Background: The overall safety and efficacy of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in frail patients is not well delineated. This systematic review aims to summarize and compare outcomes in frail and non-frail patients who underwent MT for AIS.

Methods: A systematic review of the literature was performed using PubMed, Ovid Medline, and Web of Science to identify studies with outcomes-related data for frail patients with MT-treated AIS. The recanalization rate, procedural complications, and clinical outcome at 90-day follow-up were collected.

Results: In the four included studies there were 642 frail patients and 499 non-frail patients. Frail patients had reduced rates of good functional outcomes (29% vs 42%; χ²=22, p<0.01) and increased 90-day mortality (51% vs 25%; χ²=38, p<0.01) compared with non-frail patients.

Conclusion: MT for treatment of AIS in frail patients may be associated with worse rates of morbidity and mortality along with reduced efficacy. Given that no studies to date directly compare conservative measures with endovascular management for AIS in frail patients, more studies are required to further evaluate and identify characteristics that may improve outcomes in these patients.

Keywords: Stroke; Thrombectomy.