Related Experiment Video
Updated: Apr 23, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Patient selection for stroke endovascular therapy--DWI-ASPECTS thresholds should vary among age groups: insights from
F Danière1, K Lobotesis2, P Machi1
1From the Departments of Neuroradiology (F.D., P.M., O.E., C.R., J.F.V., G.G., C.D., A.B., V.C.).
Insights
Mechanical thrombectomy benefits patients with large-vessel occlusion strokes, with outcomes varying by age. Younger patients and those with smaller infarcts show better results after endovascular intervention.
Area of Science:
- Neurology
- Interventional Radiology
- Geriatrics
Background:
- Large-vessel occlusion (LVO) strokes require timely intervention.
- Endovascular treatment, including mechanical thrombectomy, is a key therapy for LVO.
- Patient age and infarct volume influence treatment outcomes.
Purpose of the Study:
- To evaluate the effectiveness of endovascular intervention for LVO strokes.
- To analyze outcomes based on patient age subgroups.
- To determine if age influences the benefits of mechanical thrombectomy.
Main Methods:
- Retrospective analysis of patients with anterior circulation LVO within 6 hours of symptom onset.
- Patients were stratified into age groups: <50, 50-59, 60-69, 70-79, and ≥80 years.
- Outcomes were assessed using the modified Rankin Scale (mRS) at 3 months.
Main Results:
- Mechanical thrombectomy achieved recanalization (TICI 2b/3) in 80% of 165 patients.
- Good outcomes (mRS) at 3 months varied significantly by age: 72% in <50, 52% in 50-59, 58% in 60-69, 28% in 70-79, and 19% in ≥80 years.
- Mortality rates were higher in older groups (26-35%) compared to younger groups (<10%).
Conclusions:
- Endovascular intervention is beneficial across age groups for LVO strokes.
- Age is a significant factor in predicting outcomes after thrombectomy.
- Age-adjusted infarct volume thresholds may optimize treatment selection for elderly patients.
Background And Purpose:
The purpose of this study was to evaluate the benefits of endovascular intervention in large-vessel occlusion strokes, depending on age class.
Materials And Methods:
A clinical management protocol including intravenous treatment and mechanical thrombectomy was instigated in our center in 2009 (Prognostic Factors Related to Clinical Outcome Following Thrombectomy in Ischemic Stroke [RECOST] study). All patients with acute ischemic stroke with an anterior circulation major-vessel occlusion who presented within 6 hours were evaluated with an initial MR imaging examination and were analyzed according to age subgroups (younger than 50 years, 50-59 years, 60-69 years, 70-79 years; 80 years or older). The mRS score at 3 months was the study end point.
Results:
One hundred sixty-five patients were included in the analysis. The mean age was 67.4 years (range, 29-90 years). The mean baseline NIHSS score was 17.24 (range, 3-27). The mean DWI-derived ASPECTS was 6.4. Recanalization of TICI 2b/3 was achieved in 80%. At 3 months, 41.72% of patients had a good outcome, with a gradation of prognosis depending on the age subgroup and a clear cutoff at 70 years. Only 19% of patients older than 80 years had a good outcome at 3 months (mean ASPECTS = 7.4) with 28% for 70-79 years (mean ASPECTS = 6.8), but 58% for 60-69 years (mean ASPECTS = 6), 52% for 50-59 years (mean ASPECTS = 5.91), and 72% for younger than 50 years (mean ASPECTS = 6.31). In contrast, the mortality rate was 35% for 80 years and older, and 26% for 70-79 versus 5%-9% for younger than 70 years.
Conclusions:
The elderly may benefit from thrombectomy when their ischemic core volume is low in comparison with younger patients who still benefit from acute recanalization despite larger infarcts. Stroke volume thresholds should, therefore, be related and adjusted to the patient's age group.
