Endovascular Treatment for Patients Aged ≥80 Years with Large Ischemic Stroke

Whether endovascular treatment (EVT) remained effective and safe in patients aged ≥80 years with large ischemic stroke was unclear. We aimed to investigate the effectiveness and safety of EVT in this population.

Using data from a cohort study and randomized controlled trial, we included patients aged ≥80 years with large ischemic stroke treated with EVT or standard medical treatment (SMT) alone, and compared clinical outcomes between the two groups. Furthermore, EVT patients were dichotomized by age (80-84 and ≥85 years) to evaluate associations between age and outcomes. The primary effectiveness outcome was the distribution of 90-day modified Rankin scale (mRS) score. Safety outcomes were 90-day mortality and symptomatic intracerebral hemorrhage within 48 hours.

270 eligible patients were included, with 212 in EVT group. EVT was associated with a favorable shift in the distribution of 90-day mRS scores compared with SMT (adjusted common odds ratio 2.83, 95% confidence interval 1.48-5.70, P=0.003). Secondary effectiveness outcomes including 90-day mRS score 0-2, 0-3 and 0-4 also favored EVT. The 90-day mortality was significantly lower in EVT group (P=0.009). However, the rate of any intracerebral hemorrhage was significantly higher in EVT group (P=0.001). Notably, increasing age did not modify the treatment effect of EVT.

Among patients aged ≥80 years with large ischemic stroke, EVT was associated with more favorable 90-day functional outcomes and lower mortality than SMT, but with a higher risk of intracerebral hemorrhage. The treatment effect of EVT remained consistent regardless of age in this population.