Endovascular Thrombectomy in the Very Elderly (≥85 Years): Outcomes from a High-Volume Stroke Center

Endovascular therapy (EVT) has become the standard of care for selected patients with acute ischemic stroke due to large vessel occlusion. However, the impact of advanced age on EVT outcomes remains unclear. This study evaluated the safety, efficacy, and outcomes of EVT in elderly patients (85 years of age or older) compared with younger individuals in a real-world cohort.

We conducted a retrospective analysis of the Stroke Research Consortium in Northern Bavaria database, identifying 581 patients with occlusion in the anterior circulation who underwent EVT. Patients were stratified by age (≥85 years: n = 95; <85 years: n = 486). The primary outcome was functional recovery (FR) at 90 days, defined as an mRS score ≤ prestroke mRS or prestroke mRS +1. Secondary outcomes included good functional outcome (mRS ≤2), mortality, successful EVT (TICI ≥ 2b), and symptomatic intracerebral hemorrhage.

Elderly patients had a significantly higher 90-day mortality rate (53.8% versus 22.3%, P < .001) and lower rates of good functional outcomes (1.1% versus 27.0%, P < .001). FR occurred in 13.7% of elderly patients compared with 21.0% in younger patients (P = .14). Rates of symptomatic intracerebral hemorrhage were similar (12.6% versus 8.8%, P = .34). Prestroke mRS was a significant predictor of good outcome in the elderly, with each 1-point increase associated with a 56% decrease in the odds of achieving independence (OR, 0.43; 95% CI, 0.32-0.61; P < .001).

EVT is technically feasible in elderly patients but is associated with worse outcomes and higher mortality. Age alone should not exclude patients from EVT, though careful consideration of prestroke status is essential for individualized decision-making.