the impact of age on short-term post-thrombectomy outcomes in patients aged 70 or beyond with acute ischemic stroke

Conditions: Acute Cerebral Ischemia; Endovascular Thrombectomy; Prognosis; Age Factors; Interventional Radiology; Elderly (Aged &gt;70)

Summary: a recent cochrane systematic review of 18 randomized controlled trials (rcts) comparing endovascular intervention-either mechanical thrombectomy or intra-arterial thrombolysis combined with medical treatment-to conservative medical treatment alone provided high-certainty evidence that endovascular intervention increases the likelihood of achieving a favorable functional outcome (modified rankin scale \[mrs\] score of 0-2) by 50% in patients with acute ischemic stroke (ais).1 more recently, a cross-atlantic rct was conducted to determine whether endovascular therapy (evt) plus medical care is superior to medical care alone in patients with acute proximal cerebral vessel occlusion in the anterior circulation and large infarcts, regardless of infarct size. the study confirmed a 63% increased odds of a favorable outcome with evt plus medical care. in real-world registries of evt for ais due to large-vessel occlusion in the anterior circulation, approximately one-half of patients are aged 70 and older, while 13% to 39% are aged 80 and beyond. in patients aged 70 and beyond who are evt-eligible, post-procedure mortality increases progressively with increasing age. a prospective european study found that each additional year of age was associated with an 8% decline in the likelihood of achieving a favorable functional outcome. in elderly patients, increasing age is more than just a number-it reflects a higher likelihood of significant medical comorbidities, polypharmacy, declining functional status, compromised nutritional status, and weakened immune function. research on age as a predictor of evt outcomes often compares elderly patients to much younger counterparts. however, contrasting post-evt outcomes in older adults with those under 70 is neither realistic nor appropriate due to inherent differences in baseline health, comorbidities, and physiological resilience. therefore, the investigators analyzed a prospectively registered cohort to assess whether age influences post-evt functional outcomes, using septuagenarians as the control group.

this is a retrospective, single-center cohort study evaluating patients aged ≥70 years with ais who underwent evt at kuang tien general hospital, taichung, taiwan. a registry has been established by the department of interventional neuroradiology under the supervision by dr. pao-sheng yen. for patients who the stroke center is nationally accredited for its capability to evaluate and perform evt for acute ischemic stroke emergencies. the study was approved by the institutional review board (irb) with an approval certificate numbered ktgh-11415, and informed consent was waived due to the retrospective nature of the study.

Eligibility criteria:
inclusion criteria: * age ≥70 years * acute ischemic stroke due to large-vessel occlusion (lvo) confirmed by ct angiography or mr angiography * underwent evt within the standard treatment window * available 3-month modified rankin scale (mrs) scores. exclusion criteria: * premorbid mrs score \>2 * poor imaging quality precluding assessment * lack of follow-up data.