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Thrombectomy in large vessel occlusion stroke-Does age matter?

Mehdi K Rezai1,2, Ingvild Dalen3, Rajiv Advani2,4

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Acta Neurologica Scandinavica
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Endovascular treatment (EVT) for large vessel occlusion (LVO) shows age has minimal impact on immediate neurological improvement but significantly affects long-term outcomes. Decisions regarding EVT should consider factors beyond patient age.

Keywords:
acute treatmentelderlyendovascular treatmentgeneral interventional radiologistslarge vessel occlusionstrokethrombectomy

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Geriatrics

Background:

  • Endovascular treatment (EVT) is standard for emergent large vessel occlusion (LVO).
  • Elderly patients (>80 years) are underrepresented in trials, making EVT benefits debated.
  • This demographic is growing, necessitating further research.

Purpose of the Study:

  • To evaluate the impact of age on EVT outcomes in emergent LVO patients.
  • To determine if age alone should influence EVT decisions.

Main Methods:

  • Retrospective analysis of 225 patients undergoing EVT for LVO.
  • Clinical outcomes assessed via NIHSS (National Institute of Health Stroke Scale).
  • Long-term functional outcome measured by 90-day mRS (modified Rankin Scale).

Main Results:

  • Age did not significantly predict neurological improvement (NIHSS) after adjusting for confounders.
  • Increased age correlated with higher NIHSS at discharge, though this trend became non-significant after adjustment.
  • Higher age significantly predicted worse long-term functional outcomes (mRS) even after confounder adjustment.

Conclusions:

  • Age has a limited role in predicting neurological recovery post-EVT.
  • Age significantly impacts long-term functional outcomes following EVT for LVO.
  • EVT decisions in elderly patients should not be based solely on age.