Should Patients ≥90 Years with Acute Ischemic Stroke Still Undergo Endovascular Thrombectomy?

To compare outcomes of endovascular thrombectomy (EVT) and best medical management (BMM) in patients aged ≥90 years with acute large vessel occlusion (LVO) stroke, a population underrepresented in prior trials.

Consecutive patients treated with either EVT or BMM were retrospectively included from a single-center. The primary outcome was the distribution of the modified Rankin Scale (mRS) score at 90 days after stroke onset. Baseline differences were adjusted using inverse probability weighting (IPW) based on propensity scores, followed by ordinal logistic regression on the weighted cohort to evaluate the association between treatment strategy and functional outcome.

A total of 149 patients were included, of whom 52 (34.9%) received EVT and 97 (65.1%) received BMM. After IPW, the weighted sample sizes were 102 for EVT and 138 for BMM, with baseline characteristics well balanced between the two groups. Ordinal logistic regression analysis showed that EVT was significantly associated with better functional outcomes at 90 days compared to BMM (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI]: 1.09-4.52). EVT was also associated with a higher rate of functional independence (mRS 0-2) (13.7% vs 4.3%; aOR 3.50, 95% CI: 1.30-9.45), lower mortality (40.2% vs 57.2%; aOR 0.50, 95% CI: 0.30-0.84), but increased risk of symptomatic intracranial hemorrhage (7.8% vs 2.2%; aOR 3.23, 95% CI: 1.26-8.24).

EVT was associated with improved functional outcomes and reduced mortality compared to BMM in patients aged ≥90 years with acute LVO stroke; however, the overall clinical outcome in this highly aged population remained poor.