Outcome of Mechanical Thrombectomy in Patients Older Than 85 Years: A Single Center Experience

Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS). Still, the efficacy and safety in patients older than 85 years of age are not conclusive by the present randomized controlled trials' data (RCT). Aging is a multifactorial process and the impact of MT on this specific population needs to be further analyzed.

We retrospectively reviewed 169 patients, ≥85 years old who presented with AIS and underwent MT between 2018 and 2023. Perfusion-weighted imaging (PWI) and software data were also analyzed. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 30 and 90-day follow-ups. Feasibility and safety assessments included First Pass Effect (FPE); hemorrhagic transformation (HT) evaluated according to European Cooperative Acute Stroke Study radiological classification.

Patients were subdivided into two groups (85-90 and >90 years old). A total of 107 (66%) patients had baseline PWI software on onset and median ADC value of 24.19±32.70. Anterior circulation comprised 14.3% (n=24) of the patients; 19.6% (n=33) had middle cerebral artery (MCA) M2, 1.8% (n=3) MCA M3 and 1.8% (n=3) anterior cerebral artery occlusion. Posterior circulation only comprised basilar artery occlusions (n=18). The 3-month mRS of 0-2 was 27% and mRS of 6 was 23.1%. Overall HT was found in 29.2% (n=49) of the patients, but HT1 constituted the highest ratio (70.2%; n=33).

Sub-analysis of several RCTs considered age as a limiting factor for MT in elderly patients. We suggest MT should be considered safe in well-selected candidates older than 85 years.