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Updated: Sep 30, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular thrombectomy for acute ischemic stroke in elderly patients with atrial fibrillation
Jincheng Jiao1, Sheng Liu2, Chang Cui1
1Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
Insights
Elderly patients aged 80 and above with atrial fibrillation (AF) and acute ischemic stroke (AIS) have poorer outcomes after endovascular thrombectomy (EVT). Age is a significant predictor of adverse events, requiring careful risk-benefit assessment for EVT in this population.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) presents unique challenges.
- Elderly patients, particularly those aged 80 and above, often have complex comorbidities.
- Endovascular thrombectomy (EVT) is a critical treatment for large vessel occlusion (LVO) AIS.
Purpose of the Study:
- To evaluate the clinical outcomes of endovascular thrombectomy (EVT) in elderly patients (≥80 years) with large vessel occlusion (LVO)-related acute ischemic stroke (AIS) and atrial fibrillation (AF).
- To identify predictors of functional outcomes in this specific patient cohort.
Main Methods:
- A retrospective study of consecutive AF patients who underwent EVT for anterior circulation LVO-AIS between January 2019 and December 2020.
- Primary outcome: modified Rankin Scale (mRS) score at 90 days.
- Secondary outcomes: mortality, recanalization (mTICI), and intracranial hemorrhage (ICH); multivariate logistic regression used for predictor analysis.
Main Results:
- Patients aged ≥80 years (n=42) showed significantly lower rates of good functional outcome (26.2% vs. 48.1%) and successful recanalization (78.6% vs. 94.3%) compared to younger patients.
- The ≥80 years group had a higher all-cause mortality rate (35.7% vs. 14.2%).
- Age ≥80 years was a significant predictor of poor functional outcome (OR: 3.72). Prior IVT and longer symptom-to-EVT times were associated with worse outcomes in the elderly group.
Conclusions:
- Advanced age (≥80 years) is a significant predictor of unfavorable outcomes following EVT in AIS patients with AF.
- The potential benefits of EVT in elderly AF patients must be carefully weighed against the increased risk of adverse events.
- Further research may be needed to optimize EVT strategies for octogenarian and nonagenarian stroke patients with AF.
Background:
To assess the clinical outcomes after endovascular thrombectomy (EVT) in elderly large vessel occlusion (LVO)-related acute ischemic stroke (AIS) patients with atrial fibrillation (AF).
Methods:
Between January 2019 and December 2020, consecutive AF patients who received EVT due to anterior-circulation stroke were enrolled. The primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included all-cause mortality, the recanalization status after EVT (assessed using modified thrombolysis in cerebral infarction scale, mTICI) and any intracranial hemorrhage (ICH). A multivariate logistic regression model was performed to identify predictors of the functional outcome.
Results:
A total of 148 eligible patients were finally enrolled. Among them, 42 were ≥ 80 years old. Compared to their younger counterparts, patients aged ≥80 years had lower likelihood of good functional outcome (mRS score 0-2) at 90 days (26.2% vs. 48.1%, P = 0.015), less satisfied recanalization (mTICI, 2b-3) (78.6% vs. 94.3%, P = 0.004) and higher all-cause mortality rate (35.7% vs. 14.2%, P = 0.003). A multivariable logistic regression analysis showed that age ≥ 80 years at baseline were the significant predictors for a poor functional outcome (OR: 3.72, 95% CI: 1.17-11.89, p = 0.027). Intravenous thrombolysis (IVT) prior to EVT and longer time intervals from onset of symptoms to EVT tended to be associated with poor functional outcome in patients ≥80 years old.
Conclusions:
Age ≥ 80 years was a significant predictor of unfavorable outcomes after EVT for AIS patients with AF. An increased risk of adverse events must be balanced against the benefit from EVT in elderly patients with AF.
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