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Updated: Mar 17, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Therapy for Large Vessel Stroke in the Elderly: Hope in the New Stroke Era
Andrey Lima1, Diogo C Haussen, Leticia C Rebello
1Emory University School of Medicine/Marcus Stroke and Neuroscience Center - Grady Memorial Hospital, Atlanta, Ga., USA.
Insights
Elderly patients with acute ischemic stroke (AIS) undergoing thrombectomy showed encouraging outcomes, with nearly one-third achieving independence. Optimized patient selection and modern techniques improve results for this demographic.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Geriatric Medicine
Background:
- Acute ischemic stroke (AIS) disproportionately affects the elderly, often with poor outcomes.
- Thrombectomy is a key treatment, but outcomes in older populations require further evaluation.
Purpose of the Study:
- To assess outcomes in elderly patients (≥80 years) treated with mechanical thrombectomy for anterior circulation large vessel occlusion AIS.
- To identify predictors of good clinical outcomes and optimal thresholds for final infarct volume.
Main Methods:
- Retrospective analysis of a single-center endovascular database (September 2010 - April 2015).
- Inclusion of consecutive elderly patients with large vessel occlusion AIS.
- Univariate, multivariate, and ROC analyses to determine outcome predictors and FIV thresholds.
Main Results:
- 80% successful reperfusion, 7% symptomatic intracranial hemorrhage, 41% 90-day mortality in 111 elderly patients.
- Overall good outcome (90-day mRS ≤2) was 29%; 52% in selected patients with baseline mRS 0-2.
- Alberta Stroke Program Early CT Score (ASPECTS) and baseline NIHSS score predicted good outcomes. Final infarct volume (FIV) ≤16 ml was optimal for predicting good outcomes.
Conclusions:
- Nearly one-third of elderly AIS patients achieved functional independence after thrombectomy.
- Modern thrombectomy technology and optimized patient selection offer promising results for this vulnerable population.
Background And Purpose:
Acute ischemic stroke (AIS) in the elderly encompasses approximately one-third of all AIS cases. Outcome data have been for the most part discouraging in this population. We aim to evaluate the outcomes in a large contemporary series of elderly patients treated with thrombectomy.
Methods:
Retrospective analysis of a single-center endovascular database for consecutive elderly (≥80 years) patients treated for anterior circulation large vessel occlusion AIS between September 2010 and April 2015. Univariate- and multivariate analyses were performed to identify the predictors of good clinical outcome (90-day modified Ranking Scale [mRS] ≤2). Receiver operating characteristic curves were used to calculate the optimal final infarct volume (FIV) threshold to predict good outcomes.
Results:
A total of 111 patients met our inclusion criteria (mean age 84.8 ± 4.2 years; National Institutes of Health Stroke Scale [NIHSS] score 19.1 ± 5.6; time from last-known normal to puncture, 349.6 ± 246.6 min; 33% male; 68% Alberta Stroke Program Early CT Score [ASPECTS] ≥8). The rates of successful reperfusion (modified treatment in cerebral ischemia ≥2b), symptomatic intracranial hemorrhage and 90-day mortality were 80%, 7% and 41%, respectively. The overall rate of good outcome was 29% (n = 32/111) but was 52% (n = 13/25) in patients with baseline mRS score of 0-2 who were selected based on CT perfusion and treated with stent retrievers. On multivariate analysis, only ASPECTS (OR 2.17; 95% CI 1.28-3.67.7; p = 0.004) and baseline NIHSS score (OR 0.87; 95% CI 0.77-0.97; p = 0.013) were independently associated with good outcome. A FIV ≤16 ml demonstrated the greatest accuracy for identifying good outcomes (sensitivity 75.0%, specificity 82.6%).
Conclusions:
Our results are encouraging demonstrating nearly one-third of elderly patients achieving full independence at 90 days. Contemporary treatment paradigms employing optimized patient selection and modern thrombectomy technology may result in even better outcomes.
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