Endovascular Management of Acute Ischemic Stroke in Octogenarians - Our Experience

Most contemporary clinical trials of mechanical thrombectomy (MT) have often excluded patients over the age of 80 years. Thus, evidence regarding efficacy of endovascular treatment in the octogenarians is still scanty. The present study assesses the efficacy of MT in octogenarians.

Between January 2015 to December 2020, clinical records of 27 patients (age ≥80 years), who underwent MT for stroke were queried from our database.

Out of total 229 patients, who underwent mechanical thrombectomy during the study period, 29 patients were of age ≥80 years, with a baseline disability (mRS score 0-3). We excluded two patients, who showed recanalization following iv-tPA. Recanalization through MT was achieved in 25 (93%) patients, without any event of symptomatic intracranial hemorrhage. Three had mortality and three patients required a decompressive craniectomy. Eighteen (66%) patients received intravenous thrombolysis prior to MT and nine underwent direct MT. Out of the latter group, three presented beyond the window period for thrombolysis, five were on anticoagulants, and one was in immediate post-surgical period. Baseline National Institutes of Health Stroke Scale (NIHSS) was 17 (range 8-22) and ASPECT score was six (range 3-9). Mean post-procedure NIHSS was three (range 1-10). 90-day mRS of 0-2 was achieved in 21/27 (78%) patients.

Contrary to the prevalent apprehensions of poor outcomes in elderly stroke patients treated with MT, our study showed favorable radiological and clinical results. Accordingly, more optimistic pre-procedural counselling before MT is probably advisable even in this age group of patients.