Impact of age on clinical outcomes after endovascular therapy for large ischemic stroke

The impact of age on outcomes in patients with large ischemic stroke [defined as Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≤ 5] remains unclear. This study aimed to explore the effect of age on clinical outcomes after endovascular therapy (EVT) for acute anterior circulation large ischemic stroke.

This subanalysis enrolled patients with acute large ischemic stroke from a prospective multicenter cohort registry from 38 stroke centers across China between November 2021 and February 2023. Patients were stratified into the EVT and standard medical treatment (SMT) groups. The effectiveness outcomes included the distribution of modified Rankin Scale (mRS) score and functional outcomes (mRS 0-2, 0-3, and 0-4) at 90 days. Safety outcomes included 90-day mortality, symptomatic intracranial hemorrhage (ICH) within 48 h, and any ICH.

A total of 745 eligible patients were included in the analysis. Compared with SMT, EVT showed improved 90-day outcomes across different age groups [aged ≤ 65 years, adjusted common odds ratio (acOR): 2.11, 95% confidence interval (CI) 1.16-3.81, P = 0.01; aged 66-79 years, acOR: 1.23, 95% CI 0.79-1.92, P = 0.36; aged ≥ 80 years, acOR: 2.80, 95% CI 1.26-6.22, P = 0.01], while the predicted probabilities of achieving mRS 0-3 decreased and mortality rate increased both in the EVT and SMT groups with advancing age (P _{for interaction} = 0.88 and 0.84, respectively).

In conclusion, age is a significant predictor of clinical outcomes in anterior circulation large ischemic stroke. While EVT benefits show progressive age-related decline, meaningful advantages persist even in patients aged ≥ 80 years, suggesting that age alone should not contraindicate EVT. However, further validation through large-scale randomized controlled trials is warranted.