Outcome of Mechanical Thrombectomy in Patients Older Than 85 Years: A Single Center Experience

İngilizce (OpenAlex)

Outcome of Mechanical Thrombectomy in Patients Older Than 85 Years: A Single Center ExperienceA lthough Türkiye is known for its relatively young popu- lation, recently the elderly proportion has also expanded.Overall life expectancy has increased at all ages and it is expected that also acute ischemic stroke (AIS) frequency will be higher.[1] Endovascular treatment (EVT) has revolutionized the concept of AIS treatment leading to a better outcome.So far, the proportion of elderly patients (≥85 years) in the present randomized trials of mechanical thrombectomy (MT) in AIS due to large vessel occlusion (LVO) is very low making inconclusive the efficacy and safety results.The Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trial (HERMES) study sub-analysis showed the benefit of thrombectomy in patients over 80 years old although the number of those patients was relatively low.[2] Therefore, AIS treatment outcomes in this specific population should be further analyzed.The impact of race and socioeconomic factors over aging raises the question of whether treatment Objectives: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS).Still, the efficacy and safety in patients older than 85 years of age are not conclusive by the present randomized controlled trials' data (RCT).Aging is a multifactorial process and the impact of MT on this specific population needs to be further analyzed.Methods: We retrospectively reviewed 169 patients, ≥85 years old who presented with AIS and underwent MT between 2018 and 2023.Perfusion-weighted imaging (PWI) and software data were also analyzed.Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 30 and 90-day follow-ups.Feasibility and safety assessments included First Pass Effect (FPE); hemorrhagic transformation (HT) evaluated according to European Cooperative Acute Stroke Study radiological classification.Results: Patients were subdivided into two groups (85-90 and >90 years old).A total of 107 (66%) patients had baseline PWI software on onset and median ADC value of 24.19±32.70.Anterior circulation comprised 14.3% (n=24) of the patients; 19.6% (n=33) had middle cerebral artery (MCA) M2, 1.8% (n=3) MCA M3 and 1.8% (n=3) anterior cerebral artery occlusion.Posterior circulation only comprised basilar artery occlusions (n=18).The 3-month mRS of 0-2 was 27% and mRS of 6 was 23.1%.Overall HT was found in 29.2% (n=49) of the patients, but HT1 constituted the highest ratio (70.2%; n=33).Conclusion: Sub-analysis of several RCTs considered age as a limiting factor for MT in elderly patients.We suggest MT should be considered safe in well-selected candidates older than 85 years.