Interventional stroke therapies in the elderly: are we helping?

Area of Science:

• Neurology
• Interventional Cardiology
• Geriatric Medicine

Background:

• Endovascular therapy is a crucial treatment for acute ischemic stroke (AIS).
• The safety and utilization of these advanced treatments in elderly populations, specifically those over 75, remain under-investigated.
• Understanding treatment disparities and outcomes in this demographic is critical for equitable care.

Purpose of the Study:

• To assess the utilization and safety of endovascular interventions in patients aged 75 years and older with AIS.
• To compare outcomes between older patients (≥75 years) and a younger cohort.

Main Methods:

• Retrospective review of a database including patients with AIS.
• Comparison of a cohort of patients ≥75 years old with a younger cohort.
• Assessment of National Institutes of Health Stroke Scale (NIHSS) scores, endovascular treatment rates, symptomatic intracranial hemorrhage (SICH), in-hospital mortality, and modified Rankin Scale (mRS) scores at 12 months.

Main Results:

• Endovascular treatment rates were significantly lower in patients ≥75 years (3.5%) compared to younger patients (5.9%).
• Stroke severity (NIHSS) was comparable between age groups, but older patients had worse functional outcomes (mRS) at 12 months (22% vs 52% with mild/no disability).
• Older patients experienced higher rates of SICH (24% vs 9%) and in-hospital mortality (46% vs 26%).

Conclusions:

• Patients over 75 with AIS are less likely to receive endovascular treatment.
• This older demographic faces increased risks of SICH, disability, and mortality following AIS.
• Further prospective randomized trials are necessary to identify optimal candidates for acute endovascular therapy in the elderly population.