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Stent Retriever-Based Thrombectomy in Octogenarians.

Jose E Cohen1, John M Gomori2, Ronen R Leker3

  • 1Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Interventional Neurology
|October 27, 2016
PubMed
Summary

Older patients (over 80) undergoing stent retriever thrombectomy (SRT) for large hemispheric stroke have worse outcomes. This study found higher mortality and lower functional independence in octogenarians compared to younger patients, despite similar procedural success.

Keywords:
EndovascularOctogenariansReperfusionStrokeThrombectomy

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Geriatric Medicine

Background:

  • Stent retriever-based thrombectomy (SRT) shows promise for large hemispheric stroke.
  • Previous research indicates poorer outcomes with endovascular therapy in older adults.
  • Limited data exists on newer-generation SRT in elderly stroke patients.

Purpose of the Study:

  • To evaluate the effectiveness and safety of SRT in patients aged 80 and older with large hemispheric stroke.
  • To compare neurological and functional outcomes between octogenarians and younger patients treated with SRT.

Main Methods:

  • Retrospective analysis of consecutive patients undergoing SRT for large hemispheric stroke.
  • Comparison of outcomes between two groups: patients younger than 80 and patients 80 or older.
  • Assessment of neurological recovery (modified Rankin Scale) and mortality at 90 days.

Main Results:

  • Patients over 80 (n=16) had significantly lower rates of favorable functional outcome (23% vs. 77%; p=0.031) and higher mortality (40% vs. 7%; p=0.01) compared to younger patients (n=55).
  • Age over 80 was an independent predictor of unfavorable outcome (OR 0.15) and mortality (OR 8.1).
  • Reperfusion state was a significant predictor of favorable outcome (OR 7.4).

Conclusions:

  • Octogenarians treated with SRT for large hemispheric stroke experience higher mortality and reduced functional independence.
  • Despite poorer outcomes, some elderly patients achieve favorable results, warranting further cost-effectiveness studies.
  • Age remains a critical factor influencing outcomes in endovascular stroke treatment.